クリゾチニブによる薬剤性肺障害が疑われた1例

A Suspected Case of Crizotinib-induced Lung Injury

要旨　症例は49歳男性．EML4-ALK陽性肺腺扁平上皮癌stage Ⅳの診断で，シスプラチン＋ペメトレキセド＋ベバシズマブを6コース投与した．その後，増悪したため二次治療としてクリゾチニブの内服を開始し，67日後に低酸素血症と胸部CTで両側非区域性すりガラス陰影を認めた．クリゾチニブによる薬剤性肺障害を疑い，投与中止とステロイドパルス療法を行い改善した．今後の肺癌治療においてクリゾチニブの使用機会はさらに増加すると思われ，肺障害の発症には十分な注意が必要である．

　A 47-year-old man had been diagnosed with EML4-ALK fusion gene-positive adenosquamous cell carcinoma of the lung. Cisplatin plus pemetrexed plus bevacizumab were given as first-line chemotherapy. Thereafter, the patient received crizotinib as second-line chemotherapy because of increasing primary tumor size. After 67 days of treatment, he complained of dyspnea. A chest CT showed diffuse ground glass opacities on both lungs. We stopped administering crizotinib immediately and started corticosteroid therapy because crizotinib-induced lung injury was suspected. Then his symptoms and chest CT findings were improved. We have to pay attention to develop drug-induced lung injury while using crizotinib because it is expected to increase the opportunities to use crizotinib in future on therapy of lung cancer.