Abstract YO28P
Case summary
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.
Clinical trial identification
Editorial acknowledgement
Resources from the same session
481P - Updated survival outcomes of the phase II study of low starting dose of afatinib as first-line treatment in patients with EGFR mutation-positive non-small cell lung cancer (KTORG1402)
Presenter: Toshihide Yokoyama
Session: Poster display session
Resources:
Abstract
490P - Outcomes of sequential epidermal growth factor receptor tyrosine (EGFR) tyrosine kinase inhibitor (TKI) therapy in patients with advanced non-small cell lung carcinoma (NSCLC)- a real-world institutional experience
Presenter: Yvonne Ang
Session: Poster display session
Resources:
Abstract
498P - An observational retrospective study to evaluate the incidence of acquired EGFR T790M resistance in NSCLC patients with EGFR mutation following progression after at least one prior EGFR TKI treatment in Taiwan: ARISE study
Presenter: Shang-gin Wu
Session: Poster display session
Resources:
Abstract
501P - Clinical characteristics and efficacy in non-small cell lung cancer patients with EGFR exon 20 insertion and EGFR amplification
Presenter: Xin Gao
Session: Poster display session
Resources:
Abstract
502P - Epidermal growth factor receptor tyrosine kinase inhibitor treatment response in advanced non-small cell lung cancer with uncommon mutations: A multicenter observational study
Presenter: Masaki Kanazu
Session: Poster display session
Resources:
Abstract
482P - Interim analysis from a phase IIIb, open-label study of afatinib in EGFR TKI-naïve patients (pts) with EGFR mutation-positive (EGFRm+) NSCLC
Presenter: Filippo De Marinis
Session: Poster display session
Resources:
Abstract
483P - A phase IIIb, open-label study of afatinib in EGFR TKI-naïve patients with EGFR mutation-positive NSCLC: A biomarker analysis
Presenter: Rafael Rosell
Session: Poster display session
Resources:
Abstract
484P - Activity of afatinib in patients (pts) with EGFR mutation-positive (EGFRm+) NSCLC and baseline brain metastases: Pooled analysis of three large phase IIIb trials
Presenter: Maya Gottfried
Session: Poster display session
Resources:
Abstract
491P - Clinical outcomes of leptomeningeal metastases in EGFR-mutant lung adenocarcinoma
Presenter: Chia-I Shen
Session: Poster display session
Resources:
Abstract
510P - Paclitaxel as continuation maintenance therapy in patients with advanced non-small cell lung cancer
Presenter: Suzy Gohar
Session: Poster display session
Resources:
Abstract