Title:Enteral Administration of TKIs: Report of a Response to Ceritinib in an ALK-positive NSCLC Patient and Literature Review
Volume: 19
Issue: 14
Author(s): Francesco Facchinetti, Paola Bordi*, Paola Bini, Livia Bidin, Roberta Camisa and Marcello Tiseo
Affiliation:
- Medical Oncology Unit, University Hospital of Parma, Parma,Italy
Keywords:
Non-small cell lung cancer, ALK rearrangement, ceritinib, kinase inhibitors, enteral administration, naso-gastric tube.
Abstract: Introduction: Several reports attest the feasibility and the favorable outcomes of kinase inhibitors
administration through feeding tubes or Percutaneous Endoscopic Gastrostomies (PEG),
mainly in Non-Small Cell Lung Cancer (NSCLC) patients exposed to first-generation compounds.
Here we present the case of an ALK-positive NSCLC patient who achieved cerebral and extra-cranial
disease response with ceritinib (a novel ALK inhibitor) administered through a Nasogastric Tube
(NGT). We moreover provide a review gathering clinical successes obtained with targeted agents intake
through NGT or PEG.
Case Presentation: A 53-year-old never-smoker woman was diagnosed with ALK-rearranged stage IV
lung adenocarcinoma. After a brilliant response to crizotinib and several lines of systemic therapy,
NGT positioning intended for ceritinib administration was required, given the development of a
pleuro-esophageal fistula. Enteral drug administration allowed a significant reduction of hepatic and
cerebral disease localizations.
Literature review and discussion: The majority of kinase inhibitors administration through NGT or
PEG accounts for EGFR-mutated (seven) or ALK-positive (seven, including our report) NSCLC patients.
Five additional cases concerning different malignancies were described. Enteral drug administration
was mostly required by disease-related respiratory impairment, requiring mechanical ventilation
in the emergency setting. In our case, the cerebral and extra-cranial response obtained with enteral
ceritinib intake suggests the proposition of novel inhibitors in these circumstances may take place after
first-generation compounds failure or even upfront. Indeed, their grater potency and activity against
brain metastases point out the role of their enteral administration in the first-line setting too, when a
rapid systemic and intra-cerebral disease response is required.
