2017 Volume 57 Issue 7 Pages 832-837
Background. Crizotinib, an anaplastic lymphoma kinase (ALK) inhibitor, has significant antitumor activities in ALK-positive non-small cell lung cancer (NSCLC). Some reports have shown that the penetration of crizotinib into the cerebrospinal fluid (CSF) affected its activity against central nervous system (CNS) metastases, but no analyses of the CSF concentration in elderly patients have been reported. Case. An 86-year-old man was referred to our hospital because of headache and gait disturbance. Brain magnetic resonance imaging showed multiple nodules, and chest computed tomography showed nodules in the right lung, right pleural effusion and lymphadenopathy. The patient was diagnosed with ALK-positive lung adenocarcinoma (cT1aN3M1b) with CNS metastases and received first-line therapy of crizotinib. The CNS and intrathoracic lesions decreased in size, so the CNS and serum concentrations of crizotinib were analyzed. The CSF-to-serum ratio in this patient was significantly higher than previously reported. Because of disease progression after seven months of crizotinib treatment, the patient received second-line therapy of alectinib. Conclusion. The penetration of crizotinib into the CSF may be higher in elderly patients than in non-elderly patients.
