Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases

Viola W Zhu, 1,* Misako Nagasaka, 2, 3,* Takafumi Kubota, 4 Kunil Raval, 5 Natasha Robinette, 6 Octavio Armas, 7 Wajd Al-Holou, 8 Sai-Hong Ignatius Ou 1 1Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, CA, US...

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Autores principales:	Zhu VW, Nagasaka M, Kubota T, Raval K, Robinette N, Armas O, Al-Holou W, Ou SI
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	cns radiation necrosis lorlatinib alk-rearranged nsclc alectinib (3-6) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/fa9af63c8eec466787c07f2923d66294
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spelling	oai:doaj.org-article:fa9af63c8eec466787c07f2923d662942021-12-02T09:46:23ZSymptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases1179-2728https://doaj.org/article/fa9af63c8eec466787c07f2923d662942020-01-01T00:00:00Zhttps://www.dovepress.com/symptomatic-cns-radiation-necrosis-requiring-neurosurgical-resection-d-peer-reviewed-article-LCTThttps://doaj.org/toc/1179-2728Viola W Zhu, 1,* Misako Nagasaka, 2, 3,* Takafumi Kubota, 4 Kunil Raval, 5 Natasha Robinette, 6 Octavio Armas, 7 Wajd Al-Holou, 8 Sai-Hong Ignatius Ou 1 1Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, CA, USA; 2Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA; 3Department of Advanced Medical Innovations, St. Marianna University Graduate School of Medicine, Kawasaki, Japan; 4Department of Neurology, Sapporo Nishimaruyama Hospital, Sapporo, Japan; 5Department of Pathology, Wayne State University, Detroit, MI, USA; 6Department of Oncology, Imaging Division, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA; 7Department of Pathology, Sharp Grossmont Hospital, La Mesa, CA, USA; 8Department of Neurosurgery, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA*These authors contributed equally to this workCorrespondence: Sai-Hong Ignatius OuChao Family Comprehensive Cancer Center, Department of Medicine, Division of Hematology/Oncology, University of California Irvine, 200 Manchester Dr, Suite 410, Orange, CA 92868, USATel +1714-456-8104Fax +1714-456-2242Email siou@uci.eduAbstract: Central nervous system (CNS) metastasis carries a significant morbidity and mortality in anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC). Next-generation ALK tyrosine kinase inhibitors (TKIs) are highly CNS-penetrant and have demonstrated remarkable intracranial activity across clinical studies, and yet radiation remains the mainstay of treatment modality against CNS metastasis. We have previously reported alectinib can induce CNS radiation necrosis even after a remote history of radiation (7 years post-radiation). Lorlatinib is another potent next-generation ALK TKI that can overcome many ALK resistance mutations and has been shown to have excellent activity in patients with baseline CNS metastasis. Here we report two ALK-rearranged NSCLC patients who developed radiation necrosis shortly after initiating lorlatinib following progression on the sequential treatment of crizotinib, alectinib, and brigatinib. In both cases, radiation necrosis is evidenced by serial MRI images and histological examination of the resected CNS metastasis that had previously been radiated. Our cases highlight the importance of recognizing CNS radiation necrosis that may mimic disease progression in ALK-rearranged NSCLC treated with and potentially precipated by next-generation ALK TKIs.Keywords: CNS, radiation necrosis, lorlatinib, ALK-rearranged NSCLC, alectinib  Zhu VWNagasaka MKubota TRaval KRobinette NArmas OAl-Holou WOu SIDove Medical Pressarticlecnsradiation necrosislorlatinibalk-rearranged nsclcalectinib (3-6)Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENLung Cancer: Targets and Therapy, Vol Volume 11, Pp 13-18 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	cns radiation necrosis lorlatinib alk-rearranged nsclc alectinib (3-6) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	cns radiation necrosis lorlatinib alk-rearranged nsclc alectinib (3-6) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Zhu VW Nagasaka M Kubota T Raval K Robinette N Armas O Al-Holou W Ou SI Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases
description	Viola W Zhu, 1,* Misako Nagasaka, 2, 3,* Takafumi Kubota, 4 Kunil Raval, 5 Natasha Robinette, 6 Octavio Armas, 7 Wajd Al-Holou, 8 Sai-Hong Ignatius Ou 1 1Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, CA, USA; 2Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA; 3Department of Advanced Medical Innovations, St. Marianna University Graduate School of Medicine, Kawasaki, Japan; 4Department of Neurology, Sapporo Nishimaruyama Hospital, Sapporo, Japan; 5Department of Pathology, Wayne State University, Detroit, MI, USA; 6Department of Oncology, Imaging Division, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA; 7Department of Pathology, Sharp Grossmont Hospital, La Mesa, CA, USA; 8Department of Neurosurgery, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA*These authors contributed equally to this workCorrespondence: Sai-Hong Ignatius OuChao Family Comprehensive Cancer Center, Department of Medicine, Division of Hematology/Oncology, University of California Irvine, 200 Manchester Dr, Suite 410, Orange, CA 92868, USATel +1714-456-8104Fax +1714-456-2242Email siou@uci.eduAbstract: Central nervous system (CNS) metastasis carries a significant morbidity and mortality in anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC). Next-generation ALK tyrosine kinase inhibitors (TKIs) are highly CNS-penetrant and have demonstrated remarkable intracranial activity across clinical studies, and yet radiation remains the mainstay of treatment modality against CNS metastasis. We have previously reported alectinib can induce CNS radiation necrosis even after a remote history of radiation (7 years post-radiation). Lorlatinib is another potent next-generation ALK TKI that can overcome many ALK resistance mutations and has been shown to have excellent activity in patients with baseline CNS metastasis. Here we report two ALK-rearranged NSCLC patients who developed radiation necrosis shortly after initiating lorlatinib following progression on the sequential treatment of crizotinib, alectinib, and brigatinib. In both cases, radiation necrosis is evidenced by serial MRI images and histological examination of the resected CNS metastasis that had previously been radiated. Our cases highlight the importance of recognizing CNS radiation necrosis that may mimic disease progression in ALK-rearranged NSCLC treated with and potentially precipated by next-generation ALK TKIs.Keywords: CNS, radiation necrosis, lorlatinib, ALK-rearranged NSCLC, alectinib
format	article
author	Zhu VW Nagasaka M Kubota T Raval K Robinette N Armas O Al-Holou W Ou SI
author_facet	Zhu VW Nagasaka M Kubota T Raval K Robinette N Armas O Al-Holou W Ou SI
author_sort	Zhu VW
title	Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases
title_short	Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases
title_full	Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases
title_fullStr	Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases
title_full_unstemmed	Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases
title_sort	symptomatic cns radiation necrosis requiring neurosurgical resection during treatment with lorlatinib in alk-rearranged nsclc: a report of two cases
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/fa9af63c8eec466787c07f2923d66294
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Symptomatic CNS Radiation Necrosis Requiring Neurosurgical Resection During Treatment with Lorlatinib in ALK-Rearranged NSCLC: A Report of Two Cases

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