Therapeutic use of low-dose corticosteroids to treat neutropenia resulting from crizotinib administration in a patient with anaplastic lymphoma kinase gene translocation-positive lung cancer

Abstract

Background. Neutropenia has been reported to be an adverse effect of crizotinib treatment: however, its pathogenesis remains unknown. Case. A 46-year-old male who developed cardiac tamponade was diagnosed with lung adenocarcinoma associated with pericarditis carcinomatosa and brain metastasis. Following the administration of pericardial sclerotherapy and whole-brain radiotherapy, he received two cycles of carboplatin plus pemetrexed, although the disease progressed. Thereafter, anaplastic lymphoma kinase (ALK) gene translocation was identified in metastatic lymph nodes on fluorescent in situ hybridization. Therefore, treatment with 500 mg of crizotinib daily was initiated. Although the therapy was effective, grade 3 neutropenia was noted two weeks after the start of treatment. The neutropenia persisted despite the discontinuation of crizotinib, and 10 mg of prednisolone was administered daily as treatment. The crizotinib therapy was restarted after the administration of prednisolone, and the patient exhibited a good response for the next six months. Conclusions. We herein report the case of a patient with ALK-positive lung cancer successfully treated with crizotinib in whom neutropenia was treated with prednisolone. © 2014 The Japan Lung Cancer Society.