Successful treatment with lorlatinib in a patient with meningeal carcinomatosis of ALK-positive non-small cell lung cancer resistant to alectinib and brigatinib: A case report.

Content Provider	Europe PMC
Author	Nakashima, Koki Demura, Yoshiki Kurokawa, Kosuke Takeda, Toshihiro Jikuya, Norihiro Oi, Masahiro Tada, Toshihiko Akai, Masaya Ishizuka, Tamotsu
Editor	Saranathan., Maya
Copyright Year	2021
Abstract	AbstractRationale:Although anaplastic lymphoma kinase (ALK) inhibitors are effective treatment options for ALK-positive non-small cell lung cancer (NSCLC) with central nervous system (CNS) metastasis, achieving long-term survival in patients with NSCLC with meningeal carcinomatosis resistant to ALK inhibitors is difficult. Lorlatinib, a third-generation ALK inhibitor, was designed for selective CNS penetration, and exerts potent antitumor activity against tumors resistant to first- and/or second-generation ALK inhibitors. However, there is limited information about the activity of lorlatinib in ALK inhibitor-resistant meningeal carcinomatosis. Here, we report a case of ALK-positive lung adenocarcinoma with meningeal carcinomatosis in which lorlatinib was used after resistance to alectinib and brigatinib.Patients concerns:A 55-year-old woman with no history of smoking presented to our hospital with a swelling on the left neck. Clinical imaging and histopathological examination revealed a tumor of adenocarcinoma histology in the left upper lung with no CNS metastasis.Diagnoses:The patient was diagnosed with ALK-positive lung adenocarcinoma (cT3N3M1b: stage IVA).Interventions:She received the second-generation ALK inhibitors, alectinib and brigatinib, in the first and second-line settings, respectively. However, she developed meningeal carcinomatosis. Hence, treatment with lorlatinib was initiated in the third-line setting.Outcomes:The symptoms associated with meningeal carcinomatosis, such as disturbance of consciousness and diplopia, improved dramatically. At 8 months from the initiation of lorlatinib, the patient remained well without disease progression.Lessons:Lorlatinib is an effective treatment option for patient with ALK-positive NSCLC who develop meningeal carcinomatosis resistant to second-generation ALK inhibitors. Therefore, lorlatinib should be considered in such cases, even when patients exhibit serious symptoms associated with meningeal carcinomatosis.
ISSN	00257974
Journal	Medicine
Volume Number	100
PubMed Central reference number	PMC8483815
Issue Number	39
PubMed reference number	34596160
e-ISSN	15365964
DOI	10.1097/md.0000000000027385
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2021-10-01
Publisher Place	Hagerstown, MD
Access Restriction	Open
Rights License	This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
Subject Keyword	anaplastic lymphoma kinase case report lorlatinib meningeal carcinomatosis non-small cell lung cancer
Content Type	Text
Resource Type	Article
Subject	Medicine