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Kaneko et al. J Cancer Metastasis Treat 2017;3:34-7 Journal of
DOI: 10.20517/2394-4722.2016.70
Cancer Metastasis and Treatment

www.jcmtjournal.com
Case Report Open Access

Alkaline phosphatase flare with

hyperostosis of bone metastases in lung

adenocarcinoma treated with gefitinib

Hiroto Kaneko , Kazuho Shimura , Yosuke Matsumoto , Mihoko Yoshida , Masafumi Taniwaki , Junya Kuroda 2
1
1
1
1
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1 Department of Hematology, Aiseikai Yamashina Hospital, 19-4 Shichouno-cho, Yamashina-ku, Kyoto 607-8086, Japan.
2 Department of Hematology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyou-ku, Kyoto 602-8566, Japan.
Correspondence to: Dr. Hiroto Kaneko, Department of Hematology, Aiseikai Yamashina Hospital, 19-4 Shichouno-cho, Yamashina-ku, Kyoto
607-8086, Japan. E-mail: hirotok@koto.kpu-m.ac.jp
How to cite this article: Kaneko H, Shimura K, Matsumoto Y, Yoshida M, Taniwaki M, Kuroda J. Alkaline phosphatase flare with hyperostosis of
bone metastases in lung adenocarcinoma treated with gefitinib. J Cancer Metastasis Treat 2017;3:34-7.
ABSTRACT
Article history: Alkaline phosphatase (ALP) flare has been reported to occur during cancer treatment as a
Received: 19-12-2016 favorable event, particularly in the presence of bone metastasis. There have been only a few
Accepted: 12-01-2017 reports in lung cancer and associated radiographic findings have seldom been described.
Published: 23-02-2017 The authors observed ALP flare in a female patient with lung adenocarcinoma soon after
the initiation of gefitinib. Moreover, on computed tomography, metastatic lesions of the rib
Key words: and thoracic spine showed marked hyperostosis, with sizes larger than the original bone
Alkaline phosphatase, structure, suggesting efficacy of gefitinib. The significance of such hyperostosis should be
bone metastasis, elucidated.
hyperostosis,
gefitinib

INTRODUCTION factor tyrosine kinase inhibitor (EGFR-TKI). Since
[6]
the frequency is relatively low, precise characteristics
Alkaline phosphatase (ALP) flare is known as a of ALP flare in NSCLC have not yet been elucidated,
transient elevation of serum ALP value in cancer but it seems important not to misinterpret ALP flare
patients with bone metastasis, particularly in breast or as a progression of bone lesion. We report a patient
[4]
prostatic cancer. It is generally accepted that ALP flare who presented ALP flare and unusual hyperostosis of
[1]
emerges when systemic treatment is effective, since metastatic bone lesions shortly after initiation of EGFR-
osteosclerotic change of the osteolytic lesion is seen TKI for lung adenocarcinoma.
radiographically. [2,3] Although osteosclerosis without
ALP flare has been well documented, [4,5] ALP flare is CASE REPORT
reported to occur in only 5% of non-small cell lung
cancer (NSCLC) patients treated with epidermal growth A 66-year-old woman visited our department

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