PMC5053035_01
Treatment history with an EGFR-TKI and ALK-TKIs. The vertical axis showed serum CEA values. Arrows indicated by A and B in the upper half show the time when CT images A and B in Fig. 2 were obtained, respectively. The numbers in the lower half indicate the time when CT images with the corresponding number in Fig. 3 and 5 were obtained, respectively. An asterisk indicates a 3rd generation of EGFR-TKI.
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The response to gefitinib was shown in Fig. 1, Fig. 2: Gefitinib exhibited prominent effect with a partial response lasting for 31 months. ALK-TKIs (Fig. 1). Although radiologic regression of the left lung mass and the left axillar LN was evident (Fig. 3(1) (2)), the lesion in the left anterior chest wall was gradually increased in size (Fig. 3(1) (3)).
Chest CT images during the treatment with an EGFR-TKI. A) extensive disease progression throughout in the left thorax before the start of gefitinib, and B) remarkable regression of the disease was attained with gefitinib.
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ALK-TKIs (Fig. 1). Although radiologic regression of the left lung mass and the left axillar LN was evident (Fig. 3(1) (2)), the lesion in the left anterior chest wall was gradually increased in size (Fig. 3(1) (3)).
Chest CT images during the treatment with ALK-TKIs and the combination of an EGFR-TKI with an ALK-TKI. Arrow heads in the right, central, and left column indicate the lesion in the left lung, a left axillar lymph node, and a metastatic lesion to the thoracic wall, respectively.
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In March 2014, she noticed the left axillar lymph node (LN) swelling (Fig. 3). ALK-TKIs (Fig. 1). Although radiologic regression of the left lung mass and the left axillar LN was evident (Fig. 3(1) (2)), the lesion in the left anterior chest wall was gradually increased in size (Fig. 3(1) (3)).
Immunocytochemical staining with an ALK antibody (Roche D5F3F). Almost all cancer cells were positive for ALK.
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The presence of ALK translocation was confirmed by immunocytochemistry (Fig. 4).
Chest CT images before (4) and during (5) the treatment with a 3rd generation EGFR-TKI. Each column corresponds to that in Fig. 3. Appreciable response was observed.
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In contrast, the size of the left axillar LN stayed almost the same (Fig. 5).