CMET-40. LONG-LASTING RESPONSE IN SPINAL METASTASES FROM ALK REARRANGED NON-SMALL-CELL LUNG CANCER TREATED WITH DIFFERENT ALK INHIBITORS

摘要

INTRODUCTIONAbout 40% of ALK-rearranged NSCLC patients develop brain metastases (BM), while leptomeningeal metastases (LM) occur in 5% of patients, and spinal intramedullary metastases in < 1%. Few data are available regarding the efficacy of ALK inhibitors in neoplastic spinal disease from NSCLC. CASE-REPORT: In March 2014 a 55 year-old woman developed multiple BM after 2 years from the diagnosis of an ALK-rearranged NSCLC who was receiving crizotinib. Crizotinib was continued associated with WBRT with a near-CR (RANO criteria) lasting 12 months. One year later a spinal MRI displayed multiple intramedullary enhancing lesions and diffuse leptomeningeal spread along the cauda equina, with CSF positivity for neoplastic cells. Ceritinib was started and a CR both on MRI and CSF was obtained lasting 18 months. In December 2017 the patient developed bladder dysfunction and paralytic ileus due to multiple intramedullary spinal and leptomeningeal recurrences. Considering the higher BBB penetration of lorlatinib, the patient started the drug and achieved a significant improvement of the urinary incontinence and intestinal transit after 3 months. Conversely, no change of the extent of spinal disease was observed on MRI. At this time, the patient is continuing treatment with lorlatinib and she is free of recurrence since 5 months.