UNASSIGNED: @entity9816 achieves excellent systemic control in @entity706 kinase-rearranged ( @entity7041 +) @entity1149 ( @entity1149 ); however, central nervous system (CNS) @entity3 frequently occur as an early event. Whole brain irradiation, the standard treatment, results in @entity149 . We present a case series of three @entity7041 + @entity1149 @entity1 with progressing CNS @entity3 who were treated with pulse-dose @entity9816 followed by @entity67022 . Three @entity7041 + @entity1149 @entity1 treated between 2011 and 2014 (two males, two never smokers, age range 20-54years, all @entity16242 / @entity7041 rearrangement), were diagnosed with progressing @entity75 while receiving @entity9816 . Clinico-pathological characteristics, treatments, and outcomes were analyzed. In two @entity1 the progression was limited to the CNS, and radiological evidence of leptomeningeal spread was present in one @entity1 . Sequential use of @entity9816 500mg administered once daily (pulse-dose) followed by @entity67022 on progression achieved control of the disease in the CNS for over 18 months and over 7 months in @entity1 1 and @entity1 2, respectively. This strategy provided durable CNS control after whole-brain radiotherapy failure in @entity1 1, and allowed the whole-brain radiotherapy to be deferred in @entity1 2. Limited CNS progression was documented in @entity1 3 while he was on standard-dose/pulse-dose @entity9816 for 15months; durable (over 7 months) complete remission was achieved with stereotactic radiotherapy and @entity67022 . Manipulating the @entity9816 schedule in @entity7041 + @entity1149 @entity1 with CNS @entity3 and using a novel @entity7041 -inhibitor at the time of further progression may provide durable CNS control and allow brain radiotherapy to be deferred.

Durable brain response with pulse-dose @entity9816 and @entity67022 in XXXX -positive @entity1149 compared with brain radiotherapy.

@entity7041 :: ('238', 'Gene') :: ['ALK'] @entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'Patient'] @entity706 :: ('MESH:D008223', 'Disease') :: ['anaplastic lymphoma'] @entity75 :: ('MESH:D001927', 'Disease') :: ['cerebral disease'] @entity9816 :: ('MESH:C551994', 'Chemical') :: ['crizotinib', 'Crizotinib'] @entity1149 :: ('MESH:D002289', 'Disease') :: ['NSCLC', 'non-small cell lung cancer'] @entity149 :: ('MESH:D002493', 'Disease') :: ['neurocognitive impairment'] @entity67022 :: ('MESH:C586847', 'Chemical') :: ['ceritinib'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases'] @entity16242 :: ('27436', 'Gene') :: ['echinoderm microtubule-associated protein-like 4']
@entity7041 :: (238,Gene) :: ['ALK']
