Successful Treatment with Entrectinib after Crizotinib-Induced Hepatitis in a ROS1-Positive Advanced Lung Cancer Patient: A Case Report

You-Cyuan Liang；Shian-Chin Ko

entrectinib ； crizotinib ； hepatitis ； ROS1 ； lung cancer

胸腔醫學

39卷3期（2024 / 09 / 01）

219 - 227

英文

Lung cancer, a commonly occurring cancer, is responsible for the highest number of deaths in Taiwan, regardless of gender. Targeted therapy is more effective than chemotherapy in treating advanced pulmonary adenocarcinoma harboring mutant driver genes. Crizotinib is an oral small-molecule tyrosine kinase inhibitor that targets anaplastic lymphoma kinase, mesenchymal-epithelial transition factor, and c-Ros oncogene 1 receptor (ROS1) tyrosine kinase. The most common adverse effects with crizotinib use are visual disorders, gastrointestinal upset and dysgeusia. However, impaired liver function and elevated aminotransferase levels are not rare. We presented the case of a 73-year-old male who was diagnosed with ROS1-positive metastatic lung adenocarcinoma under crizotinib treatment, who suffered from poor appetite, gastric pain and fullness. Elevated serum aminotransferase and bilirubin levels were found. After excluding other causes of hepatitis, the diagnosis of crizotinib-induced liver toxicity was made. The offending drug was withdrawn and oral silymarin and intravenous glycyrrhizin were given. His liver function recovered after 6 weeks, and another targeting ROS1 drug, entrectinib, was prescribed uneventfully. Due to the potential for elevated aminotransferase levels and the development of hepatitis during crizotinib treatment, we recommend close monitoring of liver function while using crizotinib.