Dataset Information

Effective treatment of advanced lung adenocarcinoma with paraneoplastic leukemoid reaction with Lorlatinib: a case report.

ABSTRACT:

Background

Lorlatinib is a new generation ALK kinase inhibitor. We describe a 52-year-old patient with ALK-positive advanced lung adenocarcinoma who achieved remission after multi-line therapy combined with paraneoplastic leukemoid reaction treated with Lorlatinib.

Case report

A 52-year-old male patient was diagnosed with stage IV right lung adenocarcinoma, ALK: (+), previously received oral Crizotinib and Alectinib. Blood routine showed white blood cells abnormally elevated after disease progression, and maximum white blood cell count was 179.14×10^9/L. The patient was enrolled in study entitled "a phase II, multicenter, open-label, dual-cohort study to evaluate the efficacy and safety of LORLATINIB monotherapy in ALK inhibitor-treated locally advanced or metastatic ALK-positive non-small cell lung cancer patients in China". With oral Lorlatinib, the white blood cell count decreased from 179.14×10^9/L to normal after two weeks of administration. PFS was 4.5 months. When follow up imaging showed lesions progression, the white blood cell count increased again, diagnosing a paraneoplastic leukemic reaction. OS was 5.2 months.

Conclusion

In this case, fourth-line Lorlatinib treatment is effiective in ALK-positive advanced patient with paraneoplastic leukemoid reaction. ClinicalTrials.gov Identifier: NCT03909971.

SUBMITTER: Niu R

PROVIDER: S-EPMC10853376 | biostudies-literature | 2024

REPOSITORIES: biostudies-literature

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Publications

Effective treatment of advanced lung adenocarcinoma with paraneoplastic leukemoid reaction with Lorlatinib: a case report.

Niu Ruiqi R Zhang Yiruo Y Pang Jingdan J Zhou Qing Q Lei Yu Y Du Yingying Y

Frontiers in oncology 20240126

<h4>Background</h4>Lorlatinib is a new generation ALK kinase inhibitor. We describe a 52-year-old patient with ALK-positive advanced lung adenocarcinoma who achieved remission after multi-line therapy combined with paraneoplastic leukemoid reaction treated with Lorlatinib.<h4>Case report</h4>A 52-year-old male patient was diagnosed with stage IV right lung adenocarcinoma, ALK: (+), previously received oral Crizotinib and Alectinib. Blood routine showed white blood cells abnormally elevated after ...[more]

PMID: 38344203

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Project description:IntroductionParaneoplastic syndromes are common in cancers such as lung, breast, and ovarian cancers. Still, the dual paraneoplastic syndromes of ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS) and raised pancreatic enzymes at the same time are rare. EAS is due to the production of ACTH by tumors other than the pituitary gland, which stimulates the hyperplasia of the adrenal cortex to secrete excessive corticosteroids, most commonly in lung cancer. Elevated pancreatic enzymes are associated with ectopic secretion from lung cancer. Clinically, some patients with small cell lung cancer (SCLC) have atypical early clinical manifestations and may present with paraneoplastic syndrome as the first symptom.Case reportThis article describes a case of a 45-year-old male patient who was admitted to the hospital with "intermittent mild edema of both lower extremities for more than 1 month" and showed persistent low potassium without diuretic drugs and with abnormally high blood amylase and blood lipase in the exclusion of pancreatitis. The persistent low potassium was caused by unusually high cortisol levels in patients with EAS that result from large amounts of cortisol secretion. Pancreatitis was excluded, and he was finally diagnosed with extensive-stage SCLC after bronchoscopic biopsy and histopathological confirmation. The patient presented with dual paraneoplastic syndromes of SCLC combined with EAS, high pancreatic enzymes, dual metastases, high malignancy, loss of surgical opportunities, and poor prognosis. The patient died at the end of the first cycle of chemotherapy due to the combination of IV degree of myelosuppression, metabolic alkalosis, severe infection, respiratory failure, and the rapid deterioration of his condition.ConclusionMost of the clinical manifestations of lung cancer with paraneoplastic syndrome as the first symptom lack specificity. The paraneoplastic syndrome of lung cancer can appear in all stages of the disease, and if it appears before the diagnosis of lung cancer, it is of some significance in guiding the diagnosis of lung cancer. Meanwhile, when pancreatic lesions are excluded, we should consider malignancy-related hyperpancreatinemia.

Dataset Information

Effective treatment of advanced lung adenocarcinoma with paraneoplastic leukemoid reaction with Lorlatinib: a case report.

Background

Case report

Conclusion

Publications

Effective treatment of advanced lung adenocarcinoma with paraneoplastic leukemoid reaction with Lorlatinib: a case report.

Similar Datasets

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