Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Crizotinib associated complex renal cysts
- Radiologic Findings
- Figs 1. Initial chest CT shows irregular nodule in LLL, which biopsy proved lung cancer.
Fig 2-3. The patient have chemotherapy for advanced disease (lymph node metastasis in right supraclavicular area, not shown). After chemotherapy, CT scans shows decreased size of primary lung cancer in LLL. On mediastinal window setting, there are no abnormal findings in abdomen including both kidneys.
Figs 4-5. After 3 months later, CT scan with mediastinal window setting shows newly developed complicated cystic lesion in left kidney and fluid density in right perirenal space. There are no evidence of progression in primary tumor in LLL.
Fig 6. The primary lung cancer was positive ALK translocation. He had treatment with crizotinib for lung cancer.
Fig 7. After 1 year, CT scan show resolution of complicated renal cyst despite continuing crizotinib treatment.
- Brief Review
- Crizotinib is an inhibitor of several receptor tyrosine kinases, including anaplastic lymphoma kinase (ALK), hepatocyte growth factor receptor (HGFR, c-Met), and c-ros oncogene 1. It has been approved for the treatment of advanced ALK-positive non–small-cell lung cancer (NSCLC) in many countries. The development of complex renal cyst has been observed in seven (4%) patients as stated in the latest label of crizotinib published by the US Food and Drug Administration (FDA).
On recent report, among 255 crizotinib-treated patients, 22%, 3%, and 2% had preexisting simple cysts, complex cysts, or both, respectively. At the 6-month tumor assessment, 9% of all patients had acquired new cysts, and 2% of patients with preexisting cysts had developed new cysts and enlargements (>50%) of preexisting simple cysts. Asians appeared to have an increased risk of developing new cysts on treatment; Koreans in particular had 5.18 times higher odds of developing cysts than non-Asians.
The mechanisms by which crizotinib may increase the risk of developing renal cysts are currently unknown.
In all cases, no evidence of renal malignancy was found based on diagnostic testing (including follow-up with imaging scans) or clinical follow-up in any of the crizotinib-treated patients diagnosed with complex renal cysts.
Patients who developed renal cysts generally did not require dose reductions, and no patients required permanent discontinuation of crizotinib treatment due to this adverse effect. In some cases, this led to cystic invasion into adjacent tissue requiring drainage. While close monitoring is recommended, dosing modification was not generally necessary, allowing patients to continue to benefit from crizotinib treatment.
- References
- 1. Yen-Ting Lin, MD, Yu-Fen Wang, MD, James Chih-Hsin Yang, MD. Development of Renal Cysts after Crizotinib Treatment in Advanced ALK-Positive Non–Small-Cell Lung Cancer. Journal of Thoracic Oncology. 2014 Nov; 9(11): 1720-1725.
2. Schnell P, Bartlett CH, Solomon BJ, Complex renal cysts associated with crizotinib treatment. Cancer Med. 2015 Jun;4(6):887-96.
- Keywords
- Lung, kidney, Drug related disease,