Successful alectinib treatment after crizotinib-induced interstitial lung disease

Abstract

A 70-year-old woman with lung adenocarcinoma, harbouring anaplastic lymphoma kinase gene rearrangement, was treated with crizotinib as third-line chemotherapy. After 2 months, crizotinib was discontinued because of the development of crizotinib-induced interstitial lung disease (ILD). Steroid treatment was then introduced and tapered off. Following complete resolution of the interstitial shadow, cytotoxic chemotherapy was initiated, and continued for over 2 years, until new intrapulmonary lesions developed. Although there was a risk of drug-induced interstitial pneumonia, alectinib was initiated as the fifth-line therapy, without steroid supplementation, as there was no alternative treatment. No recurrence of ILD was noted at 10 months. To our knowledge, this is the first report of successful alectinib treatment after the development of crizotinib-induced ILD without the use of prednisolone.

Keywords: anaplastic lymphoma kinase‐tyrosine kinase inhibitor; interstitial lung disease.

Figure 1

Chest computed tomography scans of the 70‐year‐old female patient. Initially, a large tumor was observed in the left lung on presentation (A). The lower lobe tumor decreased in size, however, a bilateral diffuse ground‐glass opacity occurred 60 days after initiating crizotinib treatment (B).

Figure 2

Chest computed tomography scans before and after alectinib treatment. After new lesions developed following 2 years of cytotoxic chemotherapy, alectinib treatment was initiated (A). Two months later, the tumor sizes were markedly reduced; moreover, no interstitial lung disease was detected (B).