Renal insufficiency induced by anaplastic lymphoma kinase inhibitors
10.3760/cma.j.cn114015-20240711-00533
- VernacularTitle:间变性淋巴瘤激酶抑制剂致肾功能不全
- Author:
Haiting WU
1
;
Hanping WANG
;
Wei YE
;
Xuemei LI
;
Ke ZHENG
Author Information
1. 中国医学科学院北京协和医院肾内科，北京 100730
- Publication Type:Journal Article
- Keywords:
Renal insufficiency;
Anaplastic lymphoma kinase;
Adenocarcinoma of lung;
Crizotinib;
Alectinib;
Lorlatinib
- From:
Adverse Drug Reactions Journal
2025;27(4):245-247
- CountryChina
- Language:Chinese
-
Abstract:
A 66-year-old female patient with lung adenocarcinoma was treated with crizotinib [the first-generation anaplastic lymphoma kinase (ALK) inhibitors] 250 mg twice daily. Prior to treatment, the patient's liver and kidney functions were normal. One month after treatment, her serum creatinine (Scr) was 85 μmol/L, and alanine aminotransferase (ALT) was 115 U/L. After discontinuing crizotinib for 10 days, both Scr and ALT returned to normal. One month later, the patient underwent a right lower lobectomy. Crizotinib was restarted postoperatively, and she developed symptoms of lower limb edema and poor appetite. After more than 3 months of treatment, her Scr increased to 129 μmol/L, ALT was 96 U/L, and aspartate aminotransferase (AST) was 83 U/L. Crizotinib was then switched to alectinib (the second-generation ALK inhibitors) 600 mg orally twice daily, and the patient's gastrointestinal symptoms and liver function were rapidly improved. However, her Scr continued to increase gradually (140-150 μmol/L). Renal biopsy pathology indicated IgA nephropathy and acute tubular injury. After 4 months of alectinib treatment, Scr was 174 μmol/L, and the drug was promptly discontinued. One month after discontinuation, Scr decreased to 125 μmol/L. Due to tumor progression, the patient restarted alectinib at a reduced dose (300 mg twice daily). Three months later, Scr increased to 177 μmol/L. Subsequently, alectinib was replaced with lorlatinib (the third-generation ALK inhibitors) 100 mg once daily due to tumor progression. After 6 months of treatment, the tumor condition was controlled, and Scr decreased to 124 μmol/L.
