Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11006

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    P1.24-005 - Impressive retinal response to crizotinib in a patient with NSCLC and ALK translocation (ID 740)

    09:30 - 09:30  |  Author(s): A. Manfre'
    • Abstract

    Background
    Adenocarcinoma of the lung EML4-ALK-rearranged are about 5-7% of all Non-Small-Cell-Lung Cancer (NSCLC). Treatment for patients affected by metastatic adenocarcinoma of the lung harbouring an EML4-ALK translocation is the oral compound anti-Met, Crizotinib. Crizotinib is considered to be poorly active over cerebral localizations, due to a possible difficult CNS penetration.

    Methods
    Herein we report a case of a patient with adenocarcinoma of the lung and ALK translocation, with bone and retinal metastases at diagnosis and impressive response to Crizotinib in all those sites.

    Results
    In August 2012 a 43-year-old man was hospitalized for a severe impairment in his left eye, onset abruptely the day before. In his medical history no trauma had occurred in the days before hospital admission. He had been reporting cephalea for one month, mostly in the left eye area, with metamorphopsias.He underwent a fluoroangiography,showing signs of left retinal detachment due to multiple, non-primitive, retinal neoplasias, mostly in the left eye, but also in the right retina. CT-scan of the brain showed abnormal tissue in the left retina, with important choroidal swelling. A thorax CT-scan revealed a 5-cm nodule in his right lung, median lobe, with enlargement of right mediastinal lymph nodes. Bone scan showed involvement of several bones, cervical and dorsal vertebral bodies, sternum. Biopsy was done through mediastinoscopy and adenocarcinoma of the lung was diagnosed. Genetic characterizazion was: EGFR and KRAS wild type, EML4-ALK translocation, diagnosed by FISH. Clinical TNM at the diagnosis was T2aN2M1, and distant localizations were at the bone and bilateral retinal tissue, mostly on the left.The patient reported pain at his head, neck, dorsal back, severe asthenia; his left eye was off, he had been spending most of his daily time resting at bed since one week. He started to receive Crizotinib 250 mg BID orally at the beginning of October 2012. Treatment was well tolerated, with few G1 episodes of diarrhoea.In few weeks his symptoms improved with resolution of pain and asthenia, the patient returned progressively to a normal life. CT-scan showed a reduction of the main nodule in the right lung and mediastinal lymph nodes, partial response according to RECIST criteria. Surprisingly he reported an improvement in his left eye vision, he could see the light and some objects in the lower left eye field of view. Ophtalmologist reported a reduction of the temporal nodule in the right retina, while in the left retina there was an impressive reduction of the swelling; for that reason at the end of January 2013 the patient underwent surgery to the left eye for the retinal detachment, gaining a complete left eye field of view. He is still on Crizotinib and no progression of disease has been documented up to now.

    Conclusion
    Crizotinib has induced an impressive response over retinal metastasis from NSCLC; the patient had an eye off at the diagnosis of NSCLC and on treatment gained a complete left eye field of view. Crizotinib is active over cerebral tissue like retina.