Life-threatening hypertriglyceridemia-induced pancreatitis related to alectinib successfully treated by plasmapheresis: A review of the literature on metabolic toxicities associated with anaplastic lymphoma kinase inhibitors
Life-threatening hypertriglyceridemia-induced pancreatitis related to alectinib successfully treated by plasmapheresis: A review of the literature on metabolic toxicities associated with anaplastic lymphoma kinase inhibitors
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DOI：
10.1177/1078155220904141
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发表时间：
2020-02
影响因子：
1.3
通讯作者：
A. Rao;A. Reddy;C. Dinunno;Ibrahim Elali
中科院分区：
文献类型：
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作者：
A. Rao;A. Reddy;C. Dinunno;Ibrahim Elali
可操作的突变作为所有新发转移性非小细胞肺癌的标准治疗进行测试。携带间变性淋巴瘤激酶突变的肿瘤对靶向间变性淋巴瘤激酶途径的酪氨酸激酶抑制剂有反应。我们会监测患者的常见不良反应，尽管我们偶尔会遇到意想不到的副作用。病例报告：一位52岁男性，右肺门肿块，检查发现为IIIA期腺癌。他接受了同步放化疗治疗;然而，一年后疾病复发，右肺门肿块和对侧纵隔淋巴结病，活检结果为腺癌阳性。分子分析显示间变性淋巴瘤激酶重排，开始使用alectinib。治疗6个月后，他出现便血、恶心和上腹痛，并被诊断为急性胰腺炎。甘油三酯水平高于可测量水平，> 5680 mg/dL，被认为是胰腺炎的诱发事件。管理和成果：尽管接受静脉补液、胰岛素输注和抗生素治疗，但患者仍失代偿，出现呼吸衰竭、休克，需要重症监护。由于甘油三酯持续升高，开始治疗性血浆置换。第三次血浆置换后，甘油三酯水平降至359 mg/dL。在积极的多学科治疗下，他完全康复了。三个月和六个月的随访影像学研究显示右肺门有稳定的肿块样异常，无疾病进展的证据。讨论开始alectinib治疗前，患者的甘油三酯水平为420 mg/dL。虽然他喝酒，但他没有其他传统的风险因素。据我们所知，这是第一例与间变性淋巴瘤激酶抑制剂治疗相关的高脂血症诱导的急性胰腺炎。
Introduction Actionable mutations are tested as standard of care for all new metastatic non-small cell lung cancers. Tumors harboring an anaplastic lymphoma kinase mutation respond to tyrosine kinase inhibitors targeting anaplastic lymphoma kinase pathway. Patients are monitored for common adverse effects, although we occasionally encounter unexpected side effects. Case report A 52-year-old male presented with a right hilar lung mass, and workup revealed a stage IIIA adenocarcinoma. He underwent treatment with concurrent chemoradiation; however, disease recurred one year later with a right hilar mass and contralateral mediastinal lymphadenopathy, biopsy of which resulted positive for adenocarcinoma. Molecular analysis showed anaplastic lymphoma kinase rearrangement and alectinib was started. Six months into therapy, he presented with hematochezia, nausea, and epigastric pain and was diagnosed with acute pancreatitis. Triglyceride level resulted above the measurable level at >5680mg/dL, thought to be the inciting event of pancreatitis. Management and outcome: Despite treatment with intravenous hydration, insulin infusion, and antibiotics, he decompensated with development of respiratory failure, shock requiring intensive care. Therapeutic plasmapheresis was initiated due to persistently elevated triglyceride. Following the third plasmapheresis, triglyceride level decreased to 359 mg/dL. With aggressive multidisciplinary management, he made a complete recovery. Follow-up imaging studies at three and six months show a stable mass-like abnormality in the right hilum without evidence of disease progression. Discussion Prior to starting alectinib, our patient’s triglyceride level was 420 mg/dL. While he consumed alcohol, he had no other traditional risk factor. To our knowledge, this is the first reported case of hypertriglyceridemia-induced acute pancreatitis related to treatment with an anaplastic lymphoma kinase inhibitor.