ATC is an undifferentiated tumour and lethal. Conventional treatment has not demonstrated clear therapeutic efficacy in prolonging the survival in metastatic ATC. There are growing interest in the new molecular targeted therapies. We present the case of a patient with metastatic ATC who had a good response to ALK inhibitor.
The patient was a 44 years old woman who presented with the left neck swelling for two months that had progressed rapidly to the bilateral neck swelling, the axillary swelling and subsequently to an episode of seizure.
The CT brain showed a focal enhancing brain lesion at the left frontal lobe measuring 25x18mm. The positron emission tomography (PET) scan demonstrated metabolic active diseases at the thyroid gland, left frontal lobe of cerebrum, left lower lobe of lung and multiple nodal metastasis.
The histopathology of the right cervical lymph node biopsy showed metastatic carcinoma. Immunohistochemistry staining were positive for TTF-1, p40, p63, and thyroglobulin but were negative for CD30, Napsin A, BCL-2 and EBV-LMP-1. Based on all the findings stage IVC ATC was diagnosed.
The patient had a stereotactic radiosurgery (SRS) to the brain lesion. An extended NGS panel showed positive result for ALK-EML4 mutation. She was started on 250mg BD of the crizotinib and had noticed reduction in the size of the cervical node swelling however the treatment was then stopped as she developed crizotinib induced interstitial pneumonitis.
Ceritinib was started on the 9th November 2018. The cervical node swelling noticeably became smaller fourteen days later. Her condition remained stable during the subsequent clinics follow up.
A scheduled CT scan was performed at six months post treatment and showed a new metastatic deposit at right lower lobe lung nodule (1.4cm) with smaller and stable disease elsewhere. She had a radiofrequency ablation (RFA) to the right lower lung nodule, and the ceritinib was continued. She remained clinically stable to date.
ALK inhibitor was effective in controlling the disease in this patient with estimated progression free survival of approximately six months with the good quality of life. Molecular targeted therapy could be a new way forward in managing metastatic ATC.