A Case of Post-operative Recurrence ALK-positive Lung Cancer Accompanied by Liver Dysfunction and Drug Eruption Caused by Crizotinib But Not Alectinib

Abstract

Background. The safety of administering alectinib to patients who develop crizotinib-induced liver dysfunction and skin eruption is unclear. Case. A 65-year-old female patient underwent video-assisted right upper lobectomy and mediastinal lymph node dissection after being diagnosed with lung adenocarcinoma (cT1aN0M0 Stage IA). She was treated with post-operative adjuvant chemotherapy for pT1aN2M0 Stage IIIA and subsequently developed mild liver dysfunction. At three years after surgery, cancer was found to have recurred in the mediastinal lymph nodes; an EML4-ALK genetic test performed using the surgical specimens was positive. At approximately one week after the initiation of crizotinib treatment, liver dysfunction and a drug eruption occurred. We therefore reduced the dose and began alternate-day dosing; however, crizotinib was discontinued because the patient showed no improvement. The administration of alectinib was then started after radiation therapy because the patient's serum level of CEA was elevated and the tumor was increasing in size. After the administration of alectinib, tumor shrinkage was observed and a normal liver function was achieved. As a result, the alectinib treatment was continued. Conclusion. The administration of alectinib was found to be safe and effective in a patient who demonstrated drug eruption and liver dysfunction after the administration of crizotinib.