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Case Reports
. 2023 Sep 29;4(12):100581.
doi: 10.1016/j.jtocrr.2023.100581. eCollection 2023 Dec.

Salvage Therapy With Selpercatinib for RET-Rearranged NSCLC With Pralsetinib-Related Pneumonitis and Leptomeningeal Disease: A Case Report

Paolo D d'Arienzo  1 , Niamh Cunningham  1 , Hazel O'Sullivan  1 , Charlotte Grieco  1 , Virjen Patel  2 , Sanjay Popat  1   3
Affiliations
Case Reports

Salvage Therapy With Selpercatinib for RET-Rearranged NSCLC With Pralsetinib-Related Pneumonitis and Leptomeningeal Disease: A Case Report

Paolo D d'Arienzo et al. JTO Clin Res Rep. .

Abstract

Selpercatinib and pralsetinib are RET inhibitors with substantial activity in advanced RET-rearranged NSCLC. We present a case of pralsetinib-related pneumonitis and leptomeningeal and brain metastases progression during treatment suspension for pneumonitis. During recovery, selpercatinib administration led to rapid neurologic response and complete intracranial response and allowed pneumonitis resolution. This case supports the safety of selpercatinib in patients with pneumonitis on pralsetinib and highlights its marked efficacy in leptomeningeal disease.

Keywords: Case Report; Leptomeningeal disease; NSCLC; Pralsetinib; RET fusion; Selpercatinib.

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Figures

Figure 1
Figure 1
Timeline of events. GCS, Glasgow Coma Scale; Jan, January; Jul, July; Jun, June; Mar, March; NGS, next-generation sequencing; Nov, November; Oct, October; OD, once a day.
Figure 2
Figure 2
Serial magnetic resonance imaging of the brain. (A, B) Postcontrast axial T1 sequences at the level of the inferior frontal gyrus. (C, D) Postcontrast axial T1 sequences at the level of the superior cerebellum. (E, F) Postcontrast coronal T1 sequences at the level of the occipital horns of the lateral ventricles. The enhancing intra-axial metastasis within the left inferior frontal gyrus and diffuse enhancing leptomeningeal disease of the cerebellum (arrows) have disappeared.
Figure 3
Figure 3
Serial CT imaging of the chest. Panels (A) and (C) illustrate baseline axial and coronal CT imaging revealing multifocal ground-glass opacification in keeping with pralsetinib-related pneumonitis, which has significantly improved after three months of treatment with selpercatinib (found in panels [B] and [D]). CT, computed tomography.
See this image and copyright information in PMC

References

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