Significant Radiologic Response of Pancreatic Metastasis After Targeted Therapy of Ceritinib (LDK378) for ALK-Rearranged Lung Adenocarcinoma Presenting With Hyperglycemia

Abstract

Pancreatic metastasis from non-small cell lung cancer (NSCLC) is usually asymptomatic or presents with abdominal pain, acute pancreatitis, or jaundice. A lung primary is associated with worse survival compared to pancreatic metastases from other organs. Surgical treatment of solitary metastasis to the pancreas from NSCLC has been reviewed in several studies, one of which had a notable disease-free interval. To our knowledge, there are no prior reports of targeted therapy of pancreatic metastasis of NSCLC followed by a significant response. Herein we report the case of a 31-year-old female with a solitary pancreatic metastasis from ALK-rearranged lung adenocarcinoma despite treatment with chemotherapy and crizotinib; she presented with symptoms of hyperglycemia. Targeted therapy with ceritinib (LDK378) led to symptomatic improvement and a significant radiologic response in the lung and pancreas, but not in the brain.

Figure 1

Computed tomography (CT) scan of abdomen revealed a solitary hypodensity area compared to the normal enhanced pancreas in the body of the pancreas. Before treatment with ceritinib (a, b) the metastatic lesion was 2.5 × 1.5 cm, while after 12 weeks of treatment with ceritinib it was about 0.8 cm (c, d).

Figure 2

CT scan of the chest revealed a lobulated nodular lesion in the left lobe with enlargement of mediastinal lymph nodes (a, b); both the nodular lesion and the lymph nodes were reduced in size after 12 weeks of treatment with ceritinib (c, d).

Figure 3

MRI scan of the brain revealed multiple hyperintense metastatic lesions on T2WI (a); the metastatic lesions were significantly enlarged after 24 weeks of treatment with ceritinib (b).