Click
here to close Hello! We notice that
you are using Internet Explorer, which is not supported by Echinobase
and may cause the site to display incorrectly. We suggest using a
current version of Chrome,
FireFox,
or Safari.
Medicine (Baltimore)
2018 Aug 01;9731:e11646. doi: 10.1097/MD.0000000000011646.
Show Gene links
Show Anatomy links
Organizing pneumonia resembling disease progression in a non-small-cell lung cancer patient receiving ceritinib: A case report.
Lim SM
,
An HJ
,
Park HS
,
Kwon HJ
,
Y Kim E
,
Hur J
,
Moon YW
.
???displayArticle.abstract???
RATIONALE: Echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK), a distinct molecular entity, is highly sensitive to ALK tyrosine kinase inhibitors (TKIs) such as crizotinib or ceritinib. Interstitial lung disease is a rare (1.2%) pulmonary toxicity that can result from ALK TKIs, however, organizing pneumonia has not been reported to date.
PATIENT CONCERNS: A 45-year-old Korean female with ALK-rearranged metastatic lung adenocarcinoma underwent ceritinib treatment and exhibited a partial response, until she developed organizing pneumonia resembling disease progression.
DIAGNOSES: Multiple rebiopsies confirmed the involvement of organizing pneumonia in the pathology.
INTERVENTIONS: Ceritinib was stopped and the patient was treated with intravenous antibiotics followed by oral antibiotics for two weeks.
OUTCOMES: After recovering from organizing pneumonia, ceritinib was successfully rechallenged and the patient attained a complete response.
LESSONS: When a new mass-like lesion develops in the lungs of responding patients, benign lung conditions, including organizing pneumonia should be considered in differential diagnoses.
Figure 1. Chest CT finding at (A) the baseline showing the right middle lobe mass; (B) after one cycle showing a partial response with 78% tumor shrinkage; (C) lung mass achieving near complete response; (D) lung mass in the complete response; (E) newly developed mass-like nodules on both upper lobes and right middle lobe; and (F) disappeared organizing pneumonia in both upper lobes and right middle lobe.
Figure 2. A, H&E staining of biopsy from the right middle lobe mass showing chronic inflammation. Some inflammatory cells and macrophages are present. B, H&E staining of a biopsy specimen from the left apex mass showing organizing pneumonia. Arrows indicate that aggregates of loose fibroblasts are present. Lymphocytes are present to a variable degree within the interstitium.
Eisenhauer,
New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).
2009, Pubmed
Eisenhauer,
New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).
2009,
Pubmed
Endo,
Imaging of gefitinib-related interstitial lung disease: multi-institutional analysis by the West Japan Thoracic Oncology Group.
2006,
Pubmed
Epler,
Bronchiolitis obliterans organizing pneumonia: definition and clinical features.
1992,
Pubmed
Gainor,
Molecular Mechanisms of Resistance to First- and Second-Generation ALK Inhibitors in ALK-Rearranged Lung Cancer.
2016,
Pubmed
Kudoh,
Interstitial lung disease in Japanese patients with lung cancer: a cohort and nested case-control study.
2008,
Pubmed
Müller,
Diagnosis and management of drug-associated interstitial lung disease.
2004,
Pubmed
Soria,
First-line ceritinib versus platinum-based chemotherapy in advanced ALK-rearranged non-small-cell lung cancer (ASCEND-4): a randomised, open-label, phase 3 study.
2017,
Pubmed
Yoneda,
Interstitial Lung Disease Associated With Crizotinib in Patients With Advanced Non-Small Cell Lung Cancer: Independent Review of Four PROFILE Trials.
2017,
Pubmed