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Crizotinib-induced osteitis mimicking bone metastasis in a stage IV ALK-rearranged NSCLC patient: a case report.

克唑替尼诱导的酷似骨转移的IV期ALK重排NSCLC患者的骨炎: 病例报告。

  • 影响因子:3.29
  • DOI:10.1186/s12885-019-6486-3
  • 作者列表:"Guisier F","Piton N","Bellefleur M","Delberghe N","Avenel G","Angot E","Vittecoq O","Ould-Slimane M","Morisse-Pradier H","Salaun M","Thiberville L
  • 发表时间:2020-01-06
Abstract

BACKGROUND:Targeted therapies are a standard of care for first-line treatment of Anaplastic lymphoma kinase (ALK)-rearranged non small cell lung cancer (NSCLC). Giving the rapid pace of drug discovery and development in this area, reporting of adverse effects of ALK inhibitors is crucial. Here, we report a case of osteitis induced by an ALK inhibitor mimicking bone metastasis, a previously undescribed side effect of crizotinib. CASE PRESENTATION:A 31-year-old woman with stage IV ALK-rearranged NSCLC presented with back pain after 3 months of crizotinib treatment. Diagnostic work-up showed osteitis on the 4th and 5th thoracic vertebrae, anterior soft tissue infiltration and epiduritis, without any sign of infection. Spinal cord decompression, histological removal and osteosynthesis were performed. Histologic examination showed necrosis with abundant peripheral neutrophils, no microorganism nor malignant cell. Symptoms and Computarized Tomography-abnormalities rapidly diseappeared after crizotinib withdrawal and did not recur after ceritinib onset. CONCLUSIONS:This is the first report of crizotinib-induced osteitis. Crizotinib differs from other ALK inhibitors as it targets other kinases as well, which may have been responsible for the osteitis. Crizotinib can induce rapidly extensive osteitis, which can mimic tumor progression.

摘要

背景: 靶向治疗是间变性淋巴瘤激酶 (ALK) 重排非小细胞肺癌 (NSCLC) 一线治疗的标准治疗。鉴于这一领域药物发现和开发的快速步伐,报告ALK抑制剂的不良反应至关重要。在此,我们报告一例由一种类似骨转移的ALK抑制剂诱导的骨炎,这是一种先前未描述的克唑替尼的副作用。 病例报告: 1 例 31 岁女性IV期ALK重排NSCLC患者,接受克唑替尼治疗 3 个月后出现背痛。诊断性检查显示第 4 、 5 胸椎骨炎,前软组织浸润及腱鞘炎,无感染征象。进行脊髓减压、组织学切除和接骨术。组织学检查示坏死,周围中性粒细胞丰富,无微生物及恶性细胞。症状和计算机断层扫描-crizotinib停药后异常迅速出现,ceritinib发作后不复发。 结论: 这是crizotinib引起的骨炎的首次报道。克唑替尼与其他ALK抑制剂不同,因为它也靶向其他激酶,这可能是骨炎的原因。克唑替尼可诱导迅速广泛的骨炎,可模拟肿瘤进展。

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DOI:10.1259/bjr.20180883
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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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影响因子:2.83
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DOI:10.1007/s00520-019-04843-9
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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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