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Vol.60 No.3 contents

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- Case Report -

The Administration of Crizotinib to a ROS1-positive Advanced Non-small Cell Lung Carcinoma Patient Under Immunosuppressive Therapy After Renal Transplantation: a Case Report

Shun Takao¹, Takeshi Masuda¹, Takahiro Yamada¹, Yasushi Horimasu¹, Taku Nakashima¹, Shintaro Miyamoto¹, Hiroshi Iwamoto¹, Kazunori Fujitaka¹, Hironobu Hamada¹, Noboru Hattori^1
1Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan

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Background. Crizotinib is a molecular targeted drug for advanced lung cancer patients with ROS1 gene fusion. It is metabolized by CYP3A4. This leads to an increased blood concentration of crizotinib when it is used in combination with drugs metabolized by CYP3A4. In addition, the blood concentration of crizotinib increases in patients with renal dysfunction. Case. We herein report the case of a 53-year-old woman who started crizotinib therapy for stage IV lung adenocarcinoma (pT4N1M1a) with ROS1 gene fusion. At the start of crizotinib therapy, she was also taking everolimus, which is metabolized by CYP3A4, after renal transplantation, and had renal dysfunction. Thus, we reduced the dose of crizotinib at the start of crizotinib therapy. However, several adverse effects occurred after the start of crizotinib. Because the blood concentration of crizotinib was presumed to be in the toxic range, we discontinued everolimus and increased the dose of mycophenolate mofetil, which is not metabolized by CYP3A4. In addition, in consideration of the effects of renal dysfunction, we tapered the dose of crizotinib. This treatment controlled the adverse effects and antitumor response, enabling crizotinib treatment to be maintained under appropriate immunosuppressive therapy without rejection. Conclusion. This case suggests that crizotinib can be safely administered by adjusting the dose, even for patients on immunosuppressive therapy and with renal dysfunction.
key words: Crizotinib, Immunosuppressant, Renal transplantation, Renal dysfunction, Everolimus

Received: March 4, 2020
Accepted: April 5, 2020

JJLC 60 (3): 197-201, 2020