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Zhongguo Fei Ai Za Zhi
2021 May 20;245:372-376. doi: 10.3779/j.issn.1009-3419.2021.101.17.
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[A Case of Non-small Cell Lung Cancer Treated with Three ALK Inhibitors and Chemotherapy].
Wang J
,
Xu X
,
Sun Y
,
Li H
.
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The echinoderm microtubule associated protein-like 4 (EML4) and anaplastic lymphoma kinase (ALK) were fractured and fused to become EML4-ALK. Most of these EML4-ALK-positive non-small cell lung cancer patients respond well to the ALK inhibitor. Many patients can benefit from drug target therapy for a long time, and some patients can achieve long-term survival of more than 7 years under the optimized treatment mode. This patient has lung adenocarcinoma positive for EML4-ALK fusion gene, but the treatment outcome is obviously different from that of other patients with lung cancer positive for EML4-ALK fusion gene. After the first to third generations of ALK inhibitor targeted therapy and chemotherapy, the disease progresses rapidly, the drug resistance time is short, the survival time is short, and the benefit is limited. The patient received targeted therapy of Crizotinib, Ceritinib and Lorlatinib successively from July 15, 2019, followed by two chemotherapy courses of Bevacizumab combined with Pemetrexed and Carboplatin. The patient died on September 10, 2020, with a survival of 15 months. At the same time, the treatment showed common adverse reactions of ALK inhibitors. This paper analyzed the therapeutic effect and treatment dilemma of this patient, and provided an exploration direction for the treatment of patients with EML4-ALK fusion gene positive lung cancer. .
图 1. 历次胸部CT及两次头颅MRI扫描图像。A：胸部CT检查（2019年6月16日）：左肺门及左肺上叶占位（大小：76 mm×60 mm），考虑恶性，与左肺动脉关系密切；左肺上叶癌性淋巴管炎；左肺散在结节，不除外转移；纵隔6区淋巴结肿大；左侧少许胸腔积液；B：胸部CT检查（2019年9月10日）：左肺门及左肺上叶肿块，伴阻塞性改变，较前肿块明显缩小（大小：49 mm×33 mm）；左肺上叶癌性淋巴管炎，较前改善；原纵隔多发增大、融合淋巴结，考虑转移，较前明显缩小；左肺下叶及叶间裂微结节，较前无显著改变；C：胸部CT（2019年11月16日）：左肺门及左肺上叶肿块，伴阻塞性改变，较前2019年9月10日进展（大小：63 mm×47 mm）；左肺上叶癌性淋巴管炎可能，较前无显著改变；纵隔多发增大淋巴结，考虑转移，6区淋巴结较前增大。头颅MRI（2019年11月18日）：颅内额叶、顶叶、枕叶及右侧脑室旁多发转移瘤；D：胸部CT（2020年1月3日）：左肺门及左肺上叶肿块，伴阻塞性改变，较2019年11月16日肿块稍减小（大小：56 mm×40 mm）；左肺上叶癌性淋巴管炎可能，较前无显著改变；纵隔多发增大淋巴结，考虑转移，较前无明显改变。头颅MRI（2020年1月5日）：颅内多发转移瘤较前明显减少、缩小；E：胸部CT（2020年7月3日）：左肺门巨大肿块伴阻塞性肺不张，较2020年5月20日明显增大（大小：87 mm×139 mm）；F：胸部CT（2020年8月27日）提示肿块增大（大小：122 mm×185 mm），纵隔多发增大淋巴结，部分较前增大，左侧胸膜结节样增厚，较前进展，双侧胸腔积液。CT images of the chest and MRI images of the brain. A: left hilum and left upper lobe lung tumor (size: 76 mm×60 mm), considered malignant, and closely related to the left pulmonary artery; Carcinomatous lymphangitis of the upper lobe of the left lung; Sporadic nodules in the left lung; Mediastinal region 6 lymph node enlargement; A little pleural effusion on the left side (June 16, 2019); B: left hilum and left upper lobe mass, with obstructive changes, significantly smaller than the previous mass (size: 49 mm×33 mm); Carcinomatous lymphangitis of the upper lobe of the left lung was improved. Multiple enlarged and fused lymph nodes in the primary mediastinum were significantly smaller than before. Micronodules of the left lower lobe and interlobar fissure were not changed (September 10, 2019); C: tumor in left hilum and upper lobe of left lung, with obstructive changes, progressing compared with the images of September 10, 2019 (size: 63 mm×47 mm); Carcinomatous lymphangitis of the upper lobe of the left lung is no change. Multiple enlarged lymph nodes in the mediastinum were larger in zone 6 than before (November 16, 2019). Multiple metastases in the frontal lobe, parietal lobe, occipital lobe and right ventricle (November 18, 2019); D: left hilum and left upper lobe tumor slightly smaller than the images of November 16, 2019 (size: 56 mm×40 mm); Carcinomatous lymphangitis of the upper lobe of the left lung is no change. Multiple enlarged lymph nodes in the mediastinum were no significant changes (January 3, 2020). Multiple intracranial metastases were significantly smaller and disappeared compared with before (January 5, 2020); E: left hilar tumor with obstructive atelectasis, significantly larger than May 20, 2020 (size: 87 mm×139 mm) (July 3, 2020); F: an enlarged tumor, multiple enlarged lymph nodes in the mediastinum, some of which were larger than before, nodular thickening of the left pleura, more advanced than before, and bilateral pleural effusion (August 27, 2020). CT: computed tomography; MRI: magnetic resonance imaging.
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