Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases
Viola W Zhu, 1,* Misako Nagasaka, 2, 3,* Takafumi Kubota, 4 Kunil Raval, 5 Natasha Robinette, 6 Octavio Armas, 7 Wajd Al-Holou, 8 Sai-Hong Ignatius Ou 1 1Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, CA, US...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2020-01-01
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| Series: | Lung Cancer: Targets and Therapy |
| Subjects: | |
| Online Access: | https://www.dovepress.com/symptomatic-cns-radiation-necrosis-requiring-neurosurgical-resection-d-peer-reviewed-article-LCTT |
| _version_ | 1819195456502104064 |
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| author | Zhu VW Nagasaka M Kubota T Raval K Robinette N Armas O Al-Holou W Ou SI |
| author_facet | Zhu VW Nagasaka M Kubota T Raval K Robinette N Armas O Al-Holou W Ou SI |
| author_sort | Zhu VW |
| collection | DOAJ |
| description | Viola W Zhu, 1,* Misako Nagasaka, 2, 3,* Takafumi Kubota, 4 Kunil Raval, 5 Natasha Robinette, 6 Octavio Armas, 7 Wajd Al-Holou, 8 Sai-Hong Ignatius Ou 1 1Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, CA, USA; 2Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA; 3Department of Advanced Medical Innovations, St. Marianna University Graduate School of Medicine, Kawasaki, Japan; 4Department of Neurology, Sapporo Nishimaruyama Hospital, Sapporo, Japan; 5Department of Pathology, Wayne State University, Detroit, MI, USA; 6Department of Oncology, Imaging Division, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA; 7Department of Pathology, Sharp Grossmont Hospital, La Mesa, CA, USA; 8Department of Neurosurgery, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA*These authors contributed equally to this workCorrespondence: Sai-Hong Ignatius OuChao Family Comprehensive Cancer Center, Department of Medicine, Division of Hematology/Oncology, University of California Irvine, 200 Manchester Dr, Suite 410, Orange, CA 92868, USATel +1714-456-8104Fax +1714-456-2242Email siou@uci.eduAbstract: Central nervous system (CNS) metastasis carries a significant morbidity and mortality in anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC). Next-generation ALK tyrosine kinase inhibitors (TKIs) are highly CNS-penetrant and have demonstrated remarkable intracranial activity across clinical studies, and yet radiation remains the mainstay of treatment modality against CNS metastasis. We have previously reported alectinib can induce CNS radiation necrosis even after a remote history of radiation (7 years post-radiation). Lorlatinib is another potent next-generation ALK TKI that can overcome many ALK resistance mutations and has been shown to have excellent activity in patients with baseline CNS metastasis. Here we report two ALK-rearranged NSCLC patients who developed radiation necrosis shortly after initiating lorlatinib following progression on the sequential treatment of crizotinib, alectinib, and brigatinib. In both cases, radiation necrosis is evidenced by serial MRI images and histological examination of the resected CNS metastasis that had previously been radiated. Our cases highlight the importance of recognizing CNS radiation necrosis that may mimic disease progression in ALK-rearranged NSCLC treated with and potentially precipated by next-generation ALK TKIs.Keywords: CNS, radiation necrosis, lorlatinib, ALK-rearranged NSCLC, alectinib
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| first_indexed | 2024-12-23T02:13:03Z |
| format | Article |
| id | doaj.art-fa9af63c8eec466787c07f2923d66294 |
| institution | Directory Open Access Journal |
| issn | 1179-2728 |
| language | English |
| last_indexed | 2024-12-23T02:13:03Z |
| publishDate | 2020-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Lung Cancer: Targets and Therapy |
| spelling | doaj.art-fa9af63c8eec466787c07f2923d662942022-12-21T18:03:44ZengDove Medical PressLung Cancer: Targets and Therapy1179-27282020-01-01Volume 11131851118Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two CasesZhu VWNagasaka MKubota TRaval KRobinette NArmas OAl-Holou WOu SIViola W Zhu, 1,* Misako Nagasaka, 2, 3,* Takafumi Kubota, 4 Kunil Raval, 5 Natasha Robinette, 6 Octavio Armas, 7 Wajd Al-Holou, 8 Sai-Hong Ignatius Ou 1 1Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, CA, USA; 2Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA; 3Department of Advanced Medical Innovations, St. Marianna University Graduate School of Medicine, Kawasaki, Japan; 4Department of Neurology, Sapporo Nishimaruyama Hospital, Sapporo, Japan; 5Department of Pathology, Wayne State University, Detroit, MI, USA; 6Department of Oncology, Imaging Division, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA; 7Department of Pathology, Sharp Grossmont Hospital, La Mesa, CA, USA; 8Department of Neurosurgery, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA*These authors contributed equally to this workCorrespondence: Sai-Hong Ignatius OuChao Family Comprehensive Cancer Center, Department of Medicine, Division of Hematology/Oncology, University of California Irvine, 200 Manchester Dr, Suite 410, Orange, CA 92868, USATel +1714-456-8104Fax +1714-456-2242Email siou@uci.eduAbstract: Central nervous system (CNS) metastasis carries a significant morbidity and mortality in anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC). Next-generation ALK tyrosine kinase inhibitors (TKIs) are highly CNS-penetrant and have demonstrated remarkable intracranial activity across clinical studies, and yet radiation remains the mainstay of treatment modality against CNS metastasis. We have previously reported alectinib can induce CNS radiation necrosis even after a remote history of radiation (7 years post-radiation). Lorlatinib is another potent next-generation ALK TKI that can overcome many ALK resistance mutations and has been shown to have excellent activity in patients with baseline CNS metastasis. Here we report two ALK-rearranged NSCLC patients who developed radiation necrosis shortly after initiating lorlatinib following progression on the sequential treatment of crizotinib, alectinib, and brigatinib. In both cases, radiation necrosis is evidenced by serial MRI images and histological examination of the resected CNS metastasis that had previously been radiated. Our cases highlight the importance of recognizing CNS radiation necrosis that may mimic disease progression in ALK-rearranged NSCLC treated with and potentially precipated by next-generation ALK TKIs.Keywords: CNS, radiation necrosis, lorlatinib, ALK-rearranged NSCLC, alectinib https://www.dovepress.com/symptomatic-cns-radiation-necrosis-requiring-neurosurgical-resection-d-peer-reviewed-article-LCTTcnsradiation necrosislorlatinibalk-rearranged nsclcalectinib (3-6) |
| spellingShingle | Zhu VW Nagasaka M Kubota T Raval K Robinette N Armas O Al-Holou W Ou SI Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases Lung Cancer: Targets and Therapy cns radiation necrosis lorlatinib alk-rearranged nsclc alectinib (3-6) |
| title | Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases |
| title_full | Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases |
| title_fullStr | Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases |
| title_full_unstemmed | Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases |
| title_short | Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases |
| title_sort | symptomatic cns radiation necrosis requiring neurosurgical resection during treatment with lorlatinib in alk rearranged nsclc a report of two cases |
| topic | cns radiation necrosis lorlatinib alk-rearranged nsclc alectinib (3-6) |
| url | https://www.dovepress.com/symptomatic-cns-radiation-necrosis-requiring-neurosurgical-resection-d-peer-reviewed-article-LCTT |
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