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2018 ; 9
(28
): 20213-20218
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Successful rechallenge with ceritinib after leukocytoclastic vasculitis during
ceritinib treatment for non-small cell lung cancer harboring the EML4-ALK fusion
protein
#MMPMID29732013
Okimoto T
; Tsubata Y
; Hotta T
; Hamaguchi M
; Okuno T
; Shiratsuki Y
; Kodama A
; Nakao M
; Amano Y
; Hamaguchi S
; Kurimoto N
; Tobita R
; Isobe T
Oncotarget
2018[Apr]; 9
(28
): 20213-20218
PMID29732013
show ga
Anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitors (TKIs) dramatically
improve progression-free survival compared to cytotoxic agents. It is therefore
important to manage patients with ALK-TKIs until drug resistance occurs.
Leukocytoclastic vasculitis (LCV) is a rare complication during cancer treatment
and is associated with a variety of factors. Currently, it is unclear whether we
should withdraw a treatment when drug-induced LCV develops. We report a
40-year-old man with advanced pulmonary adenocarcinoma harboring the EML4-ALK
fusion protein who developed LCV during ceritinib treatment. Four weeks after
withdrawing ceritinib, we could successfully perform rechallenge with ceritinib
at the normal dose. Rapid and massive tumor apoptosis due to ceritinib treatment
may lead to neoantigen release and immune complexes deposition. To the best of
our knowledge, we report the first case of LCV in a patient during ALK-TKI
treatment. Following this occurrence, we were able to successfully perform
rechallenge with ceritinib. Therefore, key drugs used in a patient's treatment
regimen should not be discontinued without careful evaluation, and we should also
consider the possibility of rechallenge.