Abstract

Saida Lamine*, Hiba Zahi, Ibrahim Elghissassi, Hounaida Jerguigue, Rachida Latib, Rachid Tanz, Hassan Errihani, Youssef Omor and Mohammed Ichou

ABSTRACT

Oral targeted therapies represent an essential weapon in the therapeutic arsenal of non-small cell lung cancer (NSCLC) with detected oncogenic addiction. Anti-ALK tyrosine kinase inhibitors are seeing their indications expand in the different therapeutic lines of metastatic NSCLC with ALK rearrangement. These are generally well tolerated molecules with known and manageable side effects, however, some complications are still unknown and can be serious or even fatal. Clinical case: We report the case of a young patient with an ALK-positive bronchial adenocarcinoma (ADK) initially treated with Crizotinib for 8 months, discontinued for a rare toxicity such as bilateral osteonecrosis of the legs, then replaced by Alectinib for 3 months. He presented to the emergency room for severe abdominal pain with jaundice, vomiting and fever. Abdominal CT showed acute pancreatitis (AP) stage E of BALTHAZAR with superinfection of necrosis flows, lipasemia was elevated to 3 times the normal value with biological signs of infection and hepatocellular insufficiency. The patient was put on digestive rest with parenteral antibiotic and symptomatic treatment. The evolution at 48h was made towards clinical, biological and radiological worsening, no surgical or percutaneous drainage of the infected castings was possible due to the diffusion of the infiltration, the hemodynamic instability and the increased bleeding risk in this patient. Despite the intensification of medical treatment and resuscitation measures, his condition progressed to death from septic shock. Conclusion: Alectinib was incriminated in the occurrence of this complication after the elimination of other causes of AP, despite the absence of data from the literature reporting such cases : is it the same mechanism as acute pancreatitis by hypertriglyceridemia already described? While waiting to elucidate its pathophysiology, careful monitoring of patients under these molecules remains the only means of prevention.