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Candice Amorim De Araujo Lima Santos



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    P3.13 - Targeted Therapy (Not CME Accredited Session) (ID 979)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.13-05 - Use of Crizotinib in a Patient with a Ros Mutation Causing Elevated CPK and Resulting in Dose Limiting: Case Report (ID 14083)

      12:00 - 13:30  |  Author(s): Candice Amorim De Araujo Lima Santos

      • Abstract
      • Slides

      Background

      The use of target therapy in lung cancer has changing the story of this disease. However, the toxicity sometimes can be a challenge.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We report a clinical case in a patient with advanced lung cancer with mutation in ROS 1 that had an excelent response with Crizotinib, but developed high levels of CPK.

      4c3880bb027f159e801041b1021e88e8 Result

      Man, 75y, with an adenocarcinoma of the right lung with lesions in pleura. Tumor was assessed for EGFR mutation and ALK translocation, but were not found. We started chemotherapy with Carboplatin and Pemetrexed with partial response and, after four cycles, we continued treatment with Pemetrexed isolated. After thirteen cycles, he had bone progression and the chemotherapy was changed to Docetaxel. After that, he was submitted to three more lines of chemotherapy and immunotherapy with Nivolumabe. After four years of metastatic disease, a new bone progression with a sternal mass. new biopsy was made and found a mutation in the ROS 1 gene. He was very symptomatic, limitted performance status (ecog 4) and was admmited in the hospital. We started treatment with Crizotinib 250 mg twice daily and he had a dramatic response. After two months, ECOG was one and a PET-CT showed almost a complete response. However, the patient started cramps in the abdomem and laboratory showed a CPK of 4500 u/l. the dose of the Crizotinib was adjusted to 250mg/day and the levels of cpk started to fall. We tried to reintroduce the full dose, but the levels of CPK increases to 4800 u/l again. So, we reduced the dose with maintenance of response and better tolerability.

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      8eea62084ca7e541d918e823422bd82e Conclusion

      The increased levels of CPK with inibithors of alk is described with Alectinib. This relation with Crizotinib is not well estabilished. In this case, there was an excellent response, but the dose was limited by the increase of CPK.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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