Fatal Haemoptysis Associated with Dramatic Response to Crizotinib in an ALK-Rearranged Lung Adenocarcinoma
Published: March 1, 2016 | DOI: https://doi.org/10.7860/JCDR/2016/.7428
Elodie Mussat, Violaine Giraud, catherinejulie, Thierry Chinet, Etienne Giroux Leprieur
1. Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital – APHP, Boulogne-Billancourt, France.
2. Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital – APHP, Boulogne-Billancourt, France.
3. Faculty, Department of Pathology, Ambroise Pare Hospital – APHP, Boulogne-Billancourt, France.
4. Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital – APHP, Boulogne-Billancourt, France.
EA 4340 BCOH, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France.
5. Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital – APHP, Boulogne-Billancourt, France.
EA 4340 BCOH, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France.
Correspondence
Dr. Etienne Giroux Leprieur,
Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital – APHP,
9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France.
E-mail: etienne.giroux-leprieur@aphp.fr
The presence of an ALK (Anaplastic Lymphoma Kinase) rearrangement is a rare molecular feature in Non-Small Cell Lung Carcinoma (NSCLC), and concerns mainly non- or light smokers, young patients, with adenocarcinoma histological type. These tumours are particularly sensitive to Alk-targeted therapies, as crizotinib. Crizotinib is usually well-tolerated. We report a case of fatal haemoptysis associated with dramatic response to crizotinib in a patient with an ALK-rearranged lung adenocarcinoma. The patient presented a mediastinal invasion with tracheal involvement and compression of the right pulmonary artery. The initial evolution under crizotinib was good with tumour response. At 6 weeks of crizotinib the patient presented a massive haemoptysis with a tracheobronchial fistula and pneumomediastinum. She died of acute respiratory failure. Our case is the first to report a fatal effect of crizotinib associated with tumour necrosis and good tumour response on a massive mediastinal infiltration. Precautions are recommended with the use of crizotinib in proximal lung tumours with vascular invasion.
[
FULL TEXT ] | [ PDF]