Development of Aseptic Renal Abscess in a Patient with Non-Small-Cell Lung Cancer with ALK Translocation during Crizotinib Treatment

Carvalho, Luciana F.; Shimada, Andrea Kazumi; Neto, Manuel Santos da Cruz; Rocha, Lucila Soares da Silva; Viana, Públio César Cavalcante; Kallas, Esper G.; Katz, Artur

doi:10.4236/alc.2015.44007

Cited by 1 publication

(2 citation statements)

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“…While reported regression of the CARCs may have been hastened by drainage [ 18 – 20 ], our experience suggests that these lesions spontaneously resolve.…”

Section: Discussionmentioning

confidence: 66%

“…In both, CT guided aspiration and biopsy revealed benign histology of xanthogranulomatous inflammation with negative bacterial culture and no malignant cells evident. Several recent case reports have also documented benign pathology upon aspiration of complex cysts in patients with NSCLC treated with Crizotinib [ 18 – 20 ]. Prior knowledge and prompt recognition of CARCs may help avoid unnecessary biopsy/drainage and suboptimal treatment of lung cancer.…”

Section: Discussionmentioning

confidence: 99%

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Crizotinib Associated Renal Cysts [CARCs]: incidence and patterns of evolution

et al. 2017

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BackgroundNovel therapeutic agents recently introduced for the treatment of cancer have several unusual side effects. An increased incidence of renal cystic lesions, often with features concerning for malignancy or infection, has been reported in patients with anaplastic lymphoma kinase (ALK) - rearranged advanced non-small cell lung cancer (NSCLC) treated with Crizotinib. Many of these lesions undergo spontaneous resolution despite developing complex features on imaging. We assess the incidence and patterns of evolution of Crizotinib Associated Renal Cysts [CARCs] at our institute and provide histopathology correlation of their benign nature.MethodsA retrospective analysis of renal lesions in computerised tomography (CT) scans of 35 patients with advanced ALK-rearranged NSCLC who had been prescribed crizotinib at our institution was performed by three radiologists, who analysed the evolution of these lesions, particularly for pre-defined significant and complex changes.ResultsOf 26 patients eligible for this analysis, 4 (15%) had cysts at baseline that remained stable on crizotinib treatment while 11(42%) developed significant change in 28 renal cysts. Commonest pattern of cyst evolution was enlargement from baseline followed by spontaneous regression (17/28 lesions) while other patterns noted were stable lesions, regression from baseline and ongoing enlargement. The median maximum size reached was 23 mm (range 9 – 67 mm) after a median of 178 days (160 to 1342) on crizotinib. Complex change occurred in 12 cysts, in 7/26 (27%) patients and within 60 days of starting Crizotinib in 10 cysts. Imaging features were falsely concerning for malignancy or abscess in 4/26 patients.ConclusionMost CARCs resolve spontaneously, or have a benign evolution despite enlargement and other features concerning for malignancy or infection on imaging. This unusual manifestation of chemotherapy should be recognised, particularly by radiologists, so that inappropriate treatment decisions are avoided.

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“…While reported regression of the CARCs may have been hastened by drainage [ 18 – 20 ], our experience suggests that these lesions spontaneously resolve.…”

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%