Esophago-tracheobronchial fistula following treatment of anlotinib in advanced squamous cell lung cancer Two case reports

Rationale: Anlotinib, a novel orally administered multitargeted tyrosine kinase inhibitor, inhibiting tumor angiogenesis and growth, significantly prolonged overall survival, and progression-free survival with a manageable safety profile as a third-line therapy among refractory advanced nonsmall cell lung cancer (NSCLC) patients in ALTER 0303 trail (NCT02388919). Patient concerns: Two squamous cell lung cancer patients with mediastinal metastasis undergoing the treatment of anlotinib developed clinical symptom of cough, which was worse upon ingestion. Diagnoses: On the basis of patients' clinical symptoms and radiographic findings, they were diagnosed with acquired esophago-tracheobronchial fistula. Interventions: We treated them with fully covered self-expandable metallic stents. Outcomes: The clinical symptom of cough was immediately relieved after palliative treatment. Both patients elected to discontinue anlotinib treatment. Lessons: These 2 cases imply that a close follow-up schedule for esophago-tracheobronchial fistula should be established when squamous cell lung cancer patients with mediastinal metastasis are undergoing anlotinib therapy. Early detection and adequate treatment are essential for patient symptom relief and survival.