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Crizotinib-induced osteitis mimicking bone metastasis in a stage IV ALK-rearranged NSCLC patient: a case report
F Guisier1,2,3, N Piton4, M Bellefleur5
1Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU Charles Nicolle, Rouen, France. florian.guisier@chu-rouen.fr.
Background:
Targeted therapies are a standard of care for first-line treatment of Anaplastic lymphoma kinase (ALK)-rearranged non small cell lung cancer (NSCLC). Giving the rapid pace of drug discovery and development in this area, reporting of adverse effects of ALK inhibitors is crucial. Here, we report a case of osteitis induced by an ALK inhibitor mimicking bone metastasis, a previously undescribed side effect of crizotinib.
Case Presentation:
A 31-year-old woman with stage IV ALK-rearranged NSCLC presented with back pain after 3 months of crizotinib treatment. Diagnostic work-up showed osteitis on the 4th and 5th thoracic vertebrae, anterior soft tissue infiltration and epiduritis, without any sign of infection. Spinal cord decompression, histological removal and osteosynthesis were performed. Histologic examination showed necrosis with abundant peripheral neutrophils, no microorganism nor malignant cell. Symptoms and Computarized Tomography-abnormalities rapidly diseappeared after crizotinib withdrawal and did not recur after ceritinib onset.
Conclusions:
This is the first report of crizotinib-induced osteitis. Crizotinib differs from other ALK inhibitors as it targets other kinases as well, which may have been responsible for the osteitis. Crizotinib can induce rapidly extensive osteitis, which can mimic tumor progression.
Insights
Crizotinib, an ALK inhibitor for non-small cell lung cancer, can cause osteitis mimicking bone metastasis. This rare side effect resolved after drug withdrawal, highlighting the importance of monitoring adverse effects.
Area of Science:
- Oncology
- Pharmacology
Background:
- Anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC) is treated with targeted therapies.
- Reporting adverse effects of ALK inhibitors is crucial due to rapid drug development.
Observation:
- A patient with ALK-rearranged NSCLC developed back pain after 3 months of crizotinib treatment.
- Diagnostic work-up revealed osteitis of the thoracic vertebrae, mimicking bone metastasis.
Findings:
- Crizotinib induced osteitis, a previously undescribed side effect.
- Histological examination showed necrosis without infection or malignant cells.
- Symptoms and CT abnormalities resolved after crizotinib withdrawal and did not recur with ceritinib.
Implications:
- Crizotinib-induced osteitis can mimic tumor progression in ALK-rearranged NSCLC.
- Crizotinib's off-target kinase activity may contribute to this adverse effect.
- Close monitoring for rare side effects of ALK inhibitors is essential.
