Alectinib-associated pneumoperitoneum in stage IV non-small cell lung cancer - A case report

Maina, Renee M.; Rader, Caroline A.; Muenyi, Clarisse S.; Battini, Ramakrishna; Zalamea, Nia N.; Foretia, Denis A.

doi:10.1016/j.amsu.2022.104601

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…Our study also found that 3 adult patients presented with abdominal symptoms and were managed non-operatively with bowel rest, intravenous antibiotics, and close monitoring with noted improvement in their abdominal pain. Prior to initiation of feeding, one patient had a water-soluble contrast study performed confirming no active extravasation in the gastrointestinal tract 38 , and one patient had a repeat X-ray showing resolution of pneumoperitoneum 33 . For the last patient in this cohort, the decision to start enteral feeds was based purely on clinical progress, and a repeat CT scan prior to discharge showed a resolution of pneumoperitoneum 34 .…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review

Maina,

Rader,

Kypa

et al. 2024

Annals of Medicine &Amp; Surgery

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Background: The presence of air in the peritoneal cavity (pneumoperitoneum) is often secondary to perforated viscus. Emergent operative intervention is typically warranted in non-cancer patients. Cancer patients present a unique challenge as they have increased risk of pneumoperitoneum due to local tumor invasion, radiation therapy and frequent endoscopic procedures. There is a paucity of literature on the management of patients undergoing chemotherapy who present with pneumoperitoneum. We conducted a scoping review to identify and synthesize preliminary evidence on the presentation, management, and outcomes of this patient population. Materials and Methods: A scoping review of cases of pneumoperitoneum in cancer patients from 1990 – 2022 was conducted using the Arksey and O’Malley five-stage approach. Inclusion criteria were a known diagnosis of cancer, chemotherapy within 6 months of presentation, and imaging confirmation of pneumoperitoneum. Our exclusion criteria were cancer diagnosis at the time of presentation, perforation secondary to local cancer invasion, and last chemotherapy session greater than 6 months prior to presentation. Results: 34 cases (8 pediatric, 26 adults) were identified. The median time from the last chemotherapy treatment to presentation with pneumoperitoneum was 14 days. 21 patients were managed operatively and 13 were managed non-operatively. The most common source of perforation was multiple sites along the bowel. 30-day mortality was 33.3% for the operative cohort and 23.1% for the nonoperative group. Conclusions: Pneumoperitoneum in cancer patients remains a highly morbid condition with a mortality rate of approximately 30% regardless of the treatment approach. Non-operative management should be pursued whenever possible.

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Section: Discussionmentioning

confidence: 99%

Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review

Maina,

Rader,

Kypa

et al. 2024

Annals of Medicine &Amp; Surgery

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Alectinib

2022

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Appendicitis while on alectinib for non-small cell lung cancer: a tale of two case reports

Wheatley-Price,

Wong,

Shah

et al. 2024

Front. Oncol.

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IntroductionAberrant expression of anaplastic lymphoma kinase (ALK) is found in 3%–7% of patients with non-small cell lung cancer (NSCLC). Alectinib is a tyrosine kinase inhibitor used as first-line treatment targeting ALK-positive tumors. We herein report two cases of appendicitis highlighting it as a rare, possible adverse event of treatment with alectinib.Case presentationThe first case is a 60-year-old woman with a previous history of stage 1 lobular breast cancer and early-stage lung cancer treated with segmentectomy, subsequently presenting with ALK-positive advanced NSCLC. Treatment with alectinib resulted in partial response, but she developed gastrointestinal symptoms that were assessed with computed tomography (CT) of the abdomen revealing right lower quadrant stranding without appendiceal visualization. Her symptoms continued despite an antibiotic course with re-imaging concerning for acute appendicitis, which was successfully treated with appendectomy and amoxicillin–clavulanic acid. The second case is a previously healthy 58-year-old man with advanced ALK-positive NSCLC who was started on first-line treatment with alectinib and subsequently diagnosed with asymptomatic acute appendicitis on re-staging CT abdomen. Signs on CT resolved with amoxicillin–clavulanic acid. Definitive treatment was conducted with a delayed elective appendectomy. Both patients remained on alectinib over the courses of appendicitis without interruption.ConclusionWhile appendicitis has not been previously described as an adverse effect of alectinib, its incidence in two patients at our center within several months following the administration of alectinib raises its suspicion as a possible adverse effect.

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Alectinib-associated pneumoperitoneum in stage IV non-small cell lung cancer - A case report

Cited by 3 publications

References 14 publications

Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review

Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review

Alectinib

Appendicitis while on alectinib for non-small cell lung cancer: a tale of two case reports

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