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18F-FDG PET/CT Evaluation of Crizotinib and Lorlatinib Therapy in Metastatic ROS-1-Positive Non-Small Cell Lung
Sébastien Dejust1, Abdenasser Moubtakir1, Alain Prevost2
1From the Unité de Médecine Nucléaire.
Abstract:
ROS-1-positive non-small cell lung cancers (NSCLCs) are rare (approximately 1% of all NSCLCs) and require a first-line treatment by crizotinib. Crizotinib resistance is frequent within the first 12 months of treatment. Lorlatinib is a novel tyrosine kinase inhibitor of ROS-1 recently indicated for metastatic or locally advanced crizotinib-resistant NSCLC. We report the use of lorlatinib as second-line with a complete tumoral response after only 3 months of treatment. This case shows the major role of F-FDG PET/CT in treatment evaluation and monitoring targeted therapy in metastatic NSCLC.
Insights
ROS-1 positive non-small cell lung cancer (NSCLC) is rare and often develops crizotinib resistance. Lorlatinib shows promise as a second-line treatment, achieving complete tumor response in a patient with advanced NSCLC.
Area of Science:
- Oncology
- Pharmacology
Background:
- ROS-1-positive non-small cell lung cancer (NSCLC) accounts for ~1% of NSCLC cases.
- Crizotinib is the standard first-line therapy, but resistance develops frequently within a year.
- Lorlatinib, a novel ROS-1 tyrosine kinase inhibitor, is indicated for crizotinib-resistant metastatic or locally advanced NSCLC.
Observation:
- A case of metastatic NSCLC with ROS-1 rearrangement is presented.
- The patient received lorlatinib as second-line therapy after crizotinib treatment failure.
- Treatment response was evaluated using 2-[18F]fluoro-2-deoxy-D-glucose (F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT).
Findings:
- Complete tumoral response was achieved with lorlatinib treatment.
- Tumor regression was observed within 3 months of initiating second-line lorlatinib therapy.
- F-FDG PET/CT demonstrated significant reduction in tumor metabolic activity.
Implications:
- Lorlatinib represents a viable and effective second-line treatment option for crizotinib-resistant ROS-1-positive NSCLC.
- F-FDG PET/CT is a crucial tool for monitoring treatment efficacy and guiding targeted therapy in metastatic NSCLC.
- This case highlights the potential for rapid and complete responses with novel targeted agents in rare oncogenic-driven lung cancers.
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