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2023-06-07T19:43:40Z2023-06-07T19:43:40Z2021-01-282143https://doi.org/10.1186/s12890-020-01390-61471-2466http://hdl.handle.net/1843/54670https://orcid.org/0000-0002-4647-9788https://orcid.org/0000-0002-4647-9788https://orcid.org/0000-0003-0948-1819https://orcid.org/0000-0003-0948-1819https://orcid.org/0000-0003-2016-5593https://orcid.org/0000-0003-2016-5593Background: Besides the clinical beneft of crizotinib in ALK-rearranged metastatic non-small cell lung cancer (NSCLC), concerns about its hepatotoxicity have arisen. It is not clear whether this is a drug class side efect or if the use of other selective ALKs inhibitors is safe after this serious adverse event. While evidence from clinical trials is scarce, reports of treatment after crizotinib-induces hepatitis may add to clinical decision. Case presentation: Herein, we report a case of acute hepatitis induced by crizotinib in a 32-years-old female diagnosed with metastatic NSCLC, harboring the ALK-rearrangement. After 60 days of crizotinib therapy, the patient presented with acute hepatitis, diagnosed after investigation of non-specifc symptoms, such as nausea and fatigue. Serum aspartate aminotransferase and alanine aminotransferase levels had increased from baseline to 3010 IU/L and 9145 IU/L, respectively. Total bilirubin increased up to 7.91 mg/dL, but she did not develop liver failure. After crizotinib discontinuation, a gradual hepatic function recovery occurred. Unfortunately, during the period without specifc oncology treatment, her disease showed an unequivocal progression. Therefore, she started on alectinib with great response, and no liver function alteration recurred. Conclusions: This case suggests that alectinib, even belonging to the same drug class, could be used as an alternative agent when crizotinib is the etiology of liver damage, but more robust evidence has awaited.Antecedentes: Além do benefício clínico do crizotinibe no câncer de pulmão de células não pequenas (NSCLC) metastático com rearranjo ALK, surgiram preocupações sobre sua hepatotoxicidade. Não está claro se este é um efeito colateral da classe de medicamentos ou se o uso de outros inibidores seletivos de ALKs é seguro após esse evento adverso grave. Embora as evidências de ensaios clínicos sejam escassas, relatos de tratamento após hepatite induzida por crizotinibe podem contribuir para a decisão clínica. Apresentação do caso: Aqui, relatamos um caso de hepatite aguda induzida por crizotinibe em uma mulher de 32 anos com diagnóstico de CPCNP metastático, portador do rearranjo ALK. Após 60 dias de terapia com crizotinibe, o paciente apresentou hepatite aguda, diagnosticada após investigação de sintomas inespecíficos, como náuseas e fadiga. Os níveis séricos de aspartato aminotransferase e alanina aminotransferase aumentaram da linha de base para 3.010 UI/L e 9.145 UI/L, respectivamente. A bilirrubina total aumentou para 7,91 mg/dL, mas não evoluiu com insuficiência hepática. Após a descontinuação do crizotinibe, ocorreu uma recuperação gradual da função hepática. Infelizmente, durante o período sem tratamento oncológico específico, sua doença apresentou uma progressão inequívoca. Assim, iniciou alectinibe com ótima resposta, não havendo recidiva de alteração da função hepática. Conclusões: Este caso sugere que o alectinib, mesmo pertencente à mesma classe de fármacos, pode ser utilizado como agente alternativo quando o crizotinib é a etiologia da lesão hepática, mas aguardam-se evidências mais robustas.engUniversidade Federal de Minas GeraisUFMGBrasilHCL - HOSPITAL DAS CLINICASMED - DEPARTAMENTO DE CLÍNICA MÉDICABMC Pulmonary MedicineCarcinoma pulmonar de células não pequenasToxicidadeFígadoQuinase do linfoma anaplásicoCrizotinibeRelatos de casosCrizotinibHepatotoxicityAlectinibNon-small cell lung cancerCase reportSuccessful treatment with alectinib after crizotinib-induced hepatitis in ALK-rearranged advanced lung cancer patient: a case reportTratamento bem-sucedido com alectinibe após hepatite induzida por crizotinibe em câncer de pulmão avançado com rearranjo ALK paciente: relato de casoinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-020-01390-6Flávia Amaral DuarteLeonardo Brand RodriguesFlávia Rocha PaesPaulo Henrique Costa DinizHelena Flávia Cuba de Almada Limaapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/54670/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALSuccessful treatment with alectinib after crizotinib-induced hepatitis in ALK-rearranged advanced lung cancer patient a case report.pdfSuccessful treatment with alectinib after crizotinib-induced hepatitis in ALK-rearranged advanced lung cancer patient a case report.pdfapplication/pdf187220https://repositorio.ufmg.br/bitstream/1843/54670/2/Successful%20treatment%20with%20alectinib%20after%20crizotinib-induced%20hepatitis%20in%20ALK-rearranged%20advanced%20lung%20cancer%20patient%20a%20case%20report.pdf52777c730e6d5ac4282e6e9ce9820d77MD521843/546702023-06-07 16:43:40.276oai:repositorio.ufmg.br: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Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-06-07T19:43:40Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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