Case report: successful use of repotrectinib in a ROS1 fusion-positive lung adenocarcinoma patient with severe renal insufficiency and prior tyrosine kinase inhibitor treatment failure.
Zhengjie Liang, Hao Li
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Case in brief
A 69-year-old woman with advanced lung adenocarcinoma harboring an SDC4–ROS1 fusion had bilateral pulmonary lesions, mediastinal lymphadenopathy, and pleural effusions. After sequential crizotinib and entrectinib, she developed renal hemorrhage, renal cysts and atrophy, persistently elevated serum creatinine, and reduced estimated glomerular filtration rate, alongside tumor progression. Repotrectinib was started with close monitoring. An objective tumor response occurred, serum creatinine decreased and remained relatively stable, and no new severe drug-related adverse events were reported.
What made this case unusual
Repotrectinib was used after prior ROS1 tyrosine kinase inhibitor treatment failure in the setting of severe renal insufficiency, with both an objective tumor response and improved renal laboratory measures reported.
Diagnostic / clinical pearl
In this case, severe renal insufficiency did not preclude repotrectinib use after prior ROS1 inhibitor failure; treatment was undertaken with close monitoring and was associated with an objective response and stable, lower serum creatinine.