Case report: Successful sequential therapy of crizotinb and entrectinib in ROS1-positive non-small-cell lung cancer with brain metastasis in later-settings
Wen Dong, Jinke Zhuge, Pengli Yu, Kai Liu, Mingxing Yang, Hongkang Wang- General Medicine
Rationale:
Crizotinib has been approved in many countries for the treatment of patients with advanced
Patient concerns:
A 56-year-old man with a history of occasional smoking visited our hospital with cough, sputum, and shortness of breath.
Diagnosis:
He was diagnosed with right lung adenocarcinoma (T4N2M1a, stage IV) after image and histological examination, without
Interventions:
He received three prior lines of therapies, including chemotherapy, nivolumab monotherapy, and paclitaxel plus anlotinib, with progression-free survival (PFS) of 5, 2, and 11.5 months, respectively. Then the patient began to have headaches and dizziness, and brain magnetic resonance imaging showed multiple brain metastases. Next-generation sequencing (NGS) of the biopsy from neck lymph node identified EZR-ROS1 (1.25% abundance). After 2 months of crizotinib (250 mg daily) plus bevacizumab, all pulmonary and brain lesions decreased, but a small liver lesion was discovered. As treatment went on for another 4 months, the liver lesion continued to grow while other lesions kept decreased or stable state. NGS analysis on the peripheral blood found the disappearance of
Outcomes:
The patient had a total PFS of 13 months from sequential crizotinib and entrectinib therapy.
Lessons:
A