Long-term survival following molecular-targeted therapy for intramedullary non-small-cell lung cancer metastasis.

Surgical neurology international Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI:10.25259/SNI_603_2024
Ryo Kanematsu, Junya Hanakita, Toshiyuki Takahashi, Manabu Minami, Koichi Mitsuya
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Abstract

Background: Intramedullary spinal cord metastases (ICSMs) are very rarely curable; these patients typically have very short-term survival rates. Here, a 22-year-old male with non-small-cell lung cancer (NSCLC) later developed ICSM twice; the first C4-C7 tumor responded well to surgery, radiation, and alectinib molecular-targeted therapy. The secondary ICSM C1 lesion seen years later (i.e., likely due to alectinib having been stopped) resolved once alectinib was again administered.

Case description: A 22-year-old male with a limited smoking history presented with advanced non-small-cell lung cancer (NSCLC) treated with pulmonary surgery followed by radiotherapy and chemotherapy. Four years later, he developed cervical myelopathy attributed to a C4-C7 stage IV NSCLC ICSM (i.e., notably associated with an anaplastic lymphoma kinase [ALK] rearrangement). After cervical surgery and irradiation (40 Gy/20 fr) of the resection cavity, he was also given alectinib; the patient remained disease-free for the next 7 years, remaining on alectinib. However, 1 year after alectinib was discontinued, he experienced a newly occurrent C1 ICSM lesion; the alectinib was restarted, and his tumor regressed over the next 3 years. At present, 14 years after the original ICSM surgery, the patient remains disease free but continued alectinib (Karnofsky Performance Scale: 90%).

Conclusion: Although the prognosis for ICSM is generally poor, molecular-targeted therapies, such as alectinib, as administered in this case, may provide long-term survival for patients with ALK-positive NSCLC tumors.

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髓内非小细胞肺癌转移分子靶向治疗后的长期生存率。
背景:髓内脊髓转移瘤(ICSM)很少能治愈,这些患者的生存期通常很短。这里有一名患有非小细胞肺癌(NSCLC)的22岁男性患者,后来出现了两次髓内脊髓转移瘤;第一次C4-C7肿瘤对手术、放疗和阿来替尼分子靶向治疗反应良好。数年后出现的第二次ICSM C1病变(可能是由于阿来替尼停药所致)在再次使用阿来替尼后得到缓解:一名 22 岁的男性,吸烟史有限,曾因晚期非小细胞肺癌(NSCLC)接受肺部手术治疗,随后接受放疗和化疗。四年后,他出现了颈椎脊髓病,归因于C4-C7期NSCLC ICSM(即明显伴有无性淋巴瘤激酶[ALK]重排)。在进行了颈椎手术和切除腔照射(40 Gy/20 fr)后,他还接受了阿来替尼治疗;在接下来的 7 年中,患者一直保持无病状态,并继续服用阿来替尼。然而,在停用阿来替尼 1 年后,他又出现了新的 C1 ICSM 病变;阿来替尼被重新启用,在接下来的 3 年中,他的肿瘤有所消退。目前,距离最初的 ICSM 手术已经过去了 14 年,该患者仍未患病,但仍在继续服用阿来替尼(卡诺夫斯基表现评分:90%):结论:尽管ICSM的预后普遍较差,但分子靶向疗法,如本病例中使用的阿来替尼,可为ALK阳性NSCLC肿瘤患者提供长期生存。
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