Successful rechallenge with ceritinib after leukocytoclastic vasculitis during ceritinib treatment for non-small cell lung cancer harboring the EML4-ALK fusion protein

Tamio Okimoto; Yukari Tsubata; Takamasa Hotta; Megumi Hamaguchi; Takae Okuno; Yohei Shiratsuki; Akari Kodama; Mika Nakao; Yoshihiro Amano; Shunichi Hamaguchi; Noriaki Kurimoto; Reiko Tobita; Takeshi Isobe

doi:10.18632/oncotarget.24765

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Case Reports:

Successful rechallenge with ceritinib after leukocytoclastic vasculitis during ceritinib treatment for non-small cell lung cancer harboring the EML4-ALK fusion protein

Tamio Okimoto _, Yukari Tsubata, Takamasa Hotta, Megumi Hamaguchi, Takae Okuno, Yohei Shiratsuki, Akari Kodama, Mika Nakao, Yoshihiro Amano, Shunichi Hamaguchi, Noriaki Kurimoto, Reiko Tobita and Takeshi Isobe

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Oncotarget. 2018; 9:20213-20218. https://doi.org/10.18632/oncotarget.24765

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Abstract

Tamio Okimoto1, Yukari Tsubata1, Takamasa Hotta1, Megumi Hamaguchi1, Takae Okuno1, Yohei Shiratsuki1, Akari Kodama1, Mika Nakao1, Yoshihiro Amano1, Shunichi Hamaguchi1, Noriaki Kurimoto1, Reiko Tobita2 and Takeshi Isobe1

1Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, Shimane, Japan

2Department of Dermatology, Shimane University Faculty of Medicine, Shimane, Japan

Correspondence to:

Tamio Okimoto, email: [email protected]

Keywords: alectinib; anaplastic lymphoma kinase; ceritinib; leukocytoclastic vasculitis; non-small cell lung cancer

Received: January 06, 2018 Accepted: February 27, 2018 Published: April 13, 2018

ABSTRACT

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.

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Case Reports:

Successful rechallenge with ceritinib after leukocytoclastic vasculitis during ceritinib treatment for non-small cell lung cancer harboring the EML4-ALK fusion protein

Abstract