title: Fatal Haemoptysis Associated with Dramatic Response to Crizotinib in an ALK-Rearranged Lung Adenocarcinoma.
abstract: The presence of an ALK (Anaplastic Lymphoma Kinase) rearrangement is a rare molecular feature in Non-Small Cell Lung Carcinoma (NSCLC), and concerns mainly non- or light smokers, young patients, with adenocarcinoma histological type. These tumours are particularly sensitive to Alk-targeted therapies, as crizotinib. Crizotinib is usually well-tolerated. We report a case of fatal haemoptysis associated with dramatic response to crizotinib in a patient with an ALK-rearranged lung adenocarcinoma. The patient presented a mediastinal invasion with tracheal involvement and compression of the right pulmonary artery. The initial evolution under crizotinib was good with tumour response. At 6 weeks of crizotinib the patient presented a massive haemoptysis with a tracheobronchial fistula and pneumomediastinum. She died of acute respiratory failure. Our case is the first to report a fatal effect of crizotinib associated with tumour necrosis and good tumour response on a massive mediastinal infiltration. Precautions are recommended with the use of crizotinib in proximal lung tumours with vascular invasion.
authors.affiliation: Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France .
authors.forename: Elodie
authors.initials: E
authors.lastname: Mussat
authors.affiliation: Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France .
authors.forename: Violaine
authors.initials: V
authors.lastname: Giraud
authors.affiliation: Faculty, Department of Pathology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France .
authors.forename: Catherine
authors.initials: C
authors.lastname: Julie
authors.affiliation: Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France. EA 4340 BCOH, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France .
authors.forename: Thierry
authors.initials: T
authors.lastname: Chinet
authors.affiliation: Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France. EA 4340 BCOH, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France .
authors.forename: Etienne Giroux
authors.initials: EG
authors.lastname: Leprieur
keywords: ALK rearrangement; Non-Small Cell Lung Carcinoma; Pneumomediastinum