RESUMO
BACKGROUND: Histological transformation from non-small cell lung cancer (NSCLC) to small cell lung cancer (SCLC) with anaplastic lymphoma kinase (ALK) positivity is extremely uncommon in ALK-positive NSCLC. To date, there have been limited reports regarding cases of SCLC transformation, and the optimal therapeutic strategies and prognosis for such patients remain unclear. This case is the first to describe the effectiveness of lorlatinib in treating a patient with SCLC that transformed from NSCLC harboring the ALK fusion V1180L mutation following acquired resistance to alectinib therapy. CASE DESCRIPTION: We present a case of alectinib-induced transformation from ALK-positive NSCLC to SCLC with an ALK V1180L mutation after acquiring alectinib resistance. The patient achieved disease remission with lorlatinib treatment following ineffective chemotherapy. In April 2022, a 53-year-old male was diagnosed with ALK-positive advanced poorly differentiated adenocarcinoma with neuroendocrine differentiation in the left lower lobe of the lung. The diagnosis was accompanied by multiple bone metastases and brain metastases, categorizing the stage as cT3N2M1. Following 8 months of alectinib treatment, chest computed tomography (CT) and cranial magnetic resonance imaging (MRI) revealed disease progression. Pathological and genetic analyses indicated the transformation to pulmonary small cell carcinoma accompanied by ALK fusion V1180L mutation. After the administration of two cycles of EP chemotherapy with unsatisfactory response, oral lorlatinib therapy was initiated. A subsequent month of treatment resulted in notable reduction of the left lung lesion according to chest CT, as well as a significant decrease in intracranial lesions based on cranial MRI. After taking lorlatinib for 5 months, the lesions continue to shrink, and there is a noticeable improvement in the patient's quality of life. Currently, the patient remains in a state of sustained improvement. CONCLUSION: This study affirms the efficacy of lorlatinib in patients with ALK-positive SCLC transformation harboring the V1180L mutation. Furthermore, it underscores the imperative of conducting genetic testing in patients who transition to SCLC following ALK-TKI resistance, as targeted therapies may remain efficacious if a genetic driver is identified.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma de Pequenas Células do Pulmão , Masculino , Humanos , Pessoa de Meia-Idade , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Carcinoma de Pequenas Células do Pulmão/genética , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/genética , Qualidade de Vida , Quinase do Linfoma Anaplásico/genética , Inibidores de Proteínas Quinases/uso terapêutico , Inibidores de Proteínas Quinases/farmacologia , Lactamas Macrocíclicas , Mutação , Proteínas de Fusão Oncogênica/genética , Proteínas de Fusão Oncogênica/metabolismoRESUMO
Objective To investigate and analyze the clinical effect of shoulder joint impingement syndrome treated with shoulder arthroscopy combined with drugs.MethodsFrom January 2015 to December 2016, 20 patients suffering from impingement syndrome in People's Hospital of Fenghua District were selected as the subjects in this study.Randomly selected patients were divided into the control group and the experimental group two groups, each group of patients were 10 cases.The control group in patients with arthroscopic exploration plus subacromial decompression molding, experimental group was given drug treatment on the basis of the control group, before the end of surgery in patients with intra-articular injection of sodium hyaluronate and Compound Betamethasone Injection.The therapeutic effects of the experimental group and the control group were compared.ResultsAfter the corresponding treatment, there were no complications in the experimental group and the control group.The VAS scores, shoulder abduction and external rotation angles of the experimental group and the control group were significantly higher than those of the control group, with statistical difference (P<0.05).After treatment, the VAS score of the experimental group was (1.7±0.3) points, the external rotation angle was (36.5±13.5) degrees, and the shoulder abduction was (110.5±3.7) degrees.The score of VAS in the experimental group was significantly lower than that in the control group, and there was a statistical difference (P<0.05).ConclusionThe clinical effect of arthroscopic subacromial impingement syndrome combined with drug treatment, can effectively relieve the pain of the patients, improve the patient's shoulder to a certain extent, with further clinical promotion and application significance.
