Stage IV ALK-Positive Lung Adenocarcinoma: 7.5-Year Complete Remission with Crizotinib

Case Report

Ann Hematol Oncol. 2021; 8(6): 1350.

Stage IV ALK-Positive Lung Adenocarcinoma: 7.5-Year Complete Remission with Crizotinib

Rouabhia D¹, Audet R², Desmeules P³ and Labbé C¹*

1Division of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec City, Canada

2Centre hospitalier de la Baie des Chaleurs, Maria, Canada

3Service D’Anatomopathologie et de Cytologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Canada

*Corresponding author: Labbé C, Division of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 chemin Ste-Foy, Québec, QC, G1V 4G5, Canada

Received: April 03, 2021; Accepted: May 13, 2021; Published: May 20, 2021


Multiple lines of Anaplastic Lymphoma Kinase (ALK) Tyrosine Kinase Inhibitors (TKIs) are recommended for the treatment of ALK-positive Non-Small Cell Lung Cancer (NSCLC). This article provides an unusual case report of a 33-year-old male patient with a 91-month Progression-Free Survival (PFS) on a first-generation TKI, crizotinib.

Keywords: Lung adenocarcinoma; Crizotinib; Long progression-free survival

Case Presentation

Lung cancer is the most common cause of cancer-related death worldwide. Approximately 85% of those cases are Non-Small- Cell Lung Cancer (NSCLC); Anaplastic Lymphoma Kinase (ALK) rearrangements occur in approximately 2-5% of those tumours [1]. Crizotinib was the first ALK inhibitor used clinically in patients with ALK-positive advanced NSCLC. It has demonstrated markedly improved outcomes compared to chemotherapy, including longer PFS, greater reduction in lung cancer symptoms and greater improvement in quality of life, both in the first-line and subsequentline settings [2-4]. In Profile 1014², median Overall Survival (OS) with crizotinib in treatment-naïve patients was not reached after a 4-year follow-up, but median PFS was only 10.9 months.

Newer, more potent ALK inhibitors (alectinib, brigatinib, lorlatinib) with improved blood-brain barrier penetration have since been developed and are preferred over crizotinib in the firstline setting, with median PFS ranging from 24 to 35 months (not reached for lorlatinib after a median follow-up of 18.3 months) [5-7]. However, crizotinib is still used when next-generation ALK inhibitors are not available. Cases of ALK-rearranged lung cancer with over 5-year PFS with crizotinib as initial therapy are rarely described. Here, we present a case of 7.5-year PFS with first-line crizotinib in a young patient with metastatic lung adenocarcinoma.

In July 2010, a 33-year-old male presented with lower respiratory infection symptoms and hemoptysis. He had a light previous smoking history (less than 5 pack-year), no past medical or family history of lung disease or cancer, no toxic or asbestos exposure. Chest radiograph showed a Left Upper Lobe (LUL) infiltrate that failed to improve with antibiotics and corticosteroids. A chest Computed Tomography (CT) scan and a Positron Emission Tomography (PET) showed a 1.6cm hypermetabolic nodule in the LUL as well as a hilar metabolic lesion, without distant metastasis. Trans-thoracic biopsy showed a TTF-1 positive adenocarcinoma. Brain Magnetic Resonance Imaging (MRI) and pulmonary function tests were normal.

The patient was referred to thoracic surgery and underwent left pneumonectomy in September 2010. Final pathology showed two separate adenocarcinomas, measuring 3cm in the left hilum and 1.5cm in the LUL. Resection was incomplete with a positive venous margin (R1), and positive lymph nodes were found in stations 7, 10L and 12L. Final staging was pT4N2M0. No molecular analysis was performed at that time. The patient underwent post-operative radiotherapy and received four cycles of adjuvant cisplatin and navelbine, which were well tolerated. He was on surveillance with regular imaging in the following years.

In April 2013, the patient presented with paresthesia and partial seizures in the right arm. Brain MRI showed a 3.3cm single left parietal lesion with oedema (Figure 1). He was referred to neurosurgery in a tertiary care center and underwent surgical resection. Pathology revealed a metastasis of well differentiated adenocarcinoma of bronchopulmonary origin. Following brain surgery, the patient was also treated with gamma knife radiosurgery on the surgical bed and on a 3mm right temporal lesion that didn’t appear on the initial MRI. The contemporary PET scan unfortunately showed multiple (>5) osteoblastic bone metastases.

Citation: Rouabhia D, Audet R, Desmeules P and Labbé C. Stage IV ALK-Positive Lung Adenocarcinoma: 7.5- Year Complete Remission with Crizotinib. Ann Hematol Oncol. 2021; 8(6): 1350.