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Vol.52 No.2 contents | Japanese/English |
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- Case Report -
A Case of Adenocarcinoma of the Lung Successfully Treated with Pemetrexed as Fourth-line Chemotherapy for Multiple Liver Metastases After Acquired Resistance to Crizotinib
Masahide Mori1, Muneyoshi Kuroyama1, Shin-ichi Kagami1, Kuniomi Matsuura1, Toshihiko Yamaguchi1, Soichiro Yokota11Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, Japan
Background. Crizotinib, an inhibitor of anaplastic lymphoma kinase (ALK), is effective against lung cancer positive for echinoderm microtubule-associated protein-like 4 (EML4)-ALK. However, cases with acquired resistance to crizotinib have also been reported. Pemetrexed (PEM), a multitargeted antifolate, has been widely used as not only first-line, but also as second-line and later chemotherapy of adenocarcinoma of the lung. Case. A 39-year-old woman received a diagnosis of adenocarcinoma of the lung with right hilar and mediastinal lymph node swelling, pericardial effusion, and multiple liver and bone metastases. Treatment with erlotinib and carboplatin+paclitaxel+bevacizumab was ineffective for her liver metastases. As the lung cancer was EML4-ALK-positive, the patient was treated with crizotinib as part of a clinical study, resulting in a partial response. However, 7 months later, treatment was terminated because the liver metastases had re-enlarged and brain metastases had appeared. Consequently, the patient received combined chemotherapy consisting of PEM and carboplatin as fourth-line treatment; she showed good response, with shrinkage of the liver metastases observed after 2 courses. After 4 courses of combined chemotherapy, treatment with PEM only was continued. Gamma-knife radiosurgery was performed for a single brain metastasis, which had been detected after the eighth course (26th week) of treatment. No re-enlargement of the liver metastases was seen, as confirmed by an abdominal CT scan after the 11th course (35th week); however, treatment was terminated after the 13th course (including 9 courses of PEM only) due to a diagnosis of carcinomatous meningitis during the 43rd week. Conclusion. In the present case, PEM showed long-term efficacy as fourth-line chemotherapy against EML4-ALK-positive adenocarcinoma of the lung after the development of acquired resistance to crizotinib. However, additional cases are needed to confirm the efficacy of PEM in patients with EML4-ALK-positive lung cancer.
key words: Lung cancer, EML4-ALK, Crizotinib, Pemetrexed
Received: October 19, 2011
Accepted: February 28, 2012
JJLC 52 (2): 242-247, 2012
