Improvement of crizotinib-resistant leptomeningeal carcinomatosis by switching to alectinib in a case of non-small cell lung cancer anaplastic lymphoma kinase (ALK) translocation

Abstract

Background: Leptomeningeal carcinomatosis is a devastating complication of non-small cell lung cancer (NSCLC). We herein report a case of crizotinib-resistant leptomeningeal carcinomatosis that improved after switching to alectinib. Case: A 47-year-old female was diagnosed as having anaplastic lymphoma kinase (ALK)-translocated NSCLC and treated with crizotinib. She underwent radiosurgery for multiple brain metastases at 7 and 13 months after the administration of crizotinib. Subsequently, symptoms of a visual disturbance, dysgeusia and nausea developed after 21 months of crizotinib treatment. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed abnormal leptomeningeal enhancement. Her symptoms immediately improved after switching to alectinib. Although she required dose reduction due to drug-induced liver injury, MRI and a cerebrospinal fluid examination showed improved findings after 6 weeks of alectinib therapy. Conclusions: Alectinib treatment might be effective in the management of leptomeningeal carcinomatosis in cases of ALK-translocated NSCLC previously treated with crizotinib.