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IMAGE OF THE MONTH Diffuse Hemorrhagic Brain Metastases in an ALK Fusion Positive Patient on Crizotinib Kevin Jao, MD, MSc, FRCPC, Pascale Tomasini, MD, MSc, Catherine Labbe, MD, Mark Doherty, MD, and Frances A. Shepherd, MD, FRCPC 52-year-old woman and lifetime nonsmoker was pre- inhibitors. Interestingly, our patient presented with dif- A sented initially with pleuritic chest pain. Investigations fuse hemorrhagic metastases. The incidence of spontaneous revealed a small lower left lobe nodule, extensive intratho- intracranial hemorrhage in patients with non–small-cell lung racic lymphadenopathy, and a large adnexal lesion. Her cancer (NSCLC) with brain metastasis is estimated at 1.2%. initial brain magnetic resonance imaging was negative. There are no published reports of intracranial hemorrhage Biopsies revealed an adenocarcinoma, TTF-1 positive com- in patients with ALK-positive NSCLC treated with crizo- patible with a primary lung carcinoma. Molecular testing tinib. A recent Children’s Oncology Group trial evaluated was negative for epidermal growth factor receptor muta- single agent crizotinib in pediatric oncology patients with tions, but immunohistochemical staining revealed positiv- refractory solid tumors. Two patients with primary CNS XXX ity for ELM4-ALK fusion, which was confirmed by FISH. tumors developed intratumoral hemorrhages which were After failing standard chemotherapy, crizotinib was initi- deemed possibly related to crizotinib. Subsequently, the trial ated as second-line
Journal of Thoracic Oncology – Wolters Kluwer Health
Published: Jun 1, 2015
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