A 54-year-old, non-smoking woman was diagnosed as stage ⅣB adenocarcinoma with widespread bone metastasis (cT4N2M1c) in the First Affiliated Hospital, Zhejiang University School of Medicine. Immunohistochemistry result showed the presence of anaplastic lymphoma kinase (ALK) gene rearrangement; next-generation sequencing (NGS) indicated EML4-ALK fusion (E6:A20) with concurrent CCDC148-ALK (C1:A20), PKDCC-ALK (Pintergenic:A20)and VIT-ALK (V15:A20) fusions. After 32 weeks of alectinib treatment, the patient complained cough and exertional chest distress but had no sign of infection. Computed tomography (CT) showed bilateral diffuse ground glass opacities, suggesting a diagnosis of alectinib-related interstitial lung disease (ILD). Following corticosteroid treatment and discontinuation of alectinib, clinical presentations and CT scan gradually improved, but the primary lung lesions enlarged during the regular follow-up. The administration of crizotinib was then initiated and the disease was stable for 25 months without recurrence of primary lung lesions and ILD.
一例54岁不吸烟的女性患者因背部疼痛就诊，影像学检查提示右下肺肿块。肺部穿刺活检提示腺癌，正电子发射计算机断层显像（PET）/计算机断层扫描（CT）提示肿瘤全身骨转移，确诊为ⅣB期右下肺腺癌（cT4N2M1c）伴骨转移。免疫组织化学检测显示间变性淋巴瘤激酶（ALK）基因重排，二代测序结果提示EML4-ALK融合（E6：A20），同时伴CCDC148-ALK（C1：A20）、PKDCC-ALK（Pintergenic：A20）和VIT-ALK（V15：A20）融合。患者在接受阿来替尼治疗后第32周出现咳嗽和活动后胸闷，复查CT提示双侧弥漫性磨玻璃影，考虑阿来替尼相关的间质性肺疾病。患者在停止阿来替尼治疗并予皮质类固醇治疗后，临床症状和CT均逐渐改善，但原发性肺部病变增大。采用克唑替尼后，患者在25个月随访期间原发性肺部病变和间质性肺疾病均未复发。.
Keywords: Adenocarcinoma; Case report; Interstitial lung disease; Targeted therapy; Tyrosine kinase inhibitor.