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Alkaline phosphatase (ALP) flare has been reported to occur during cancer treatment as a favorable event, particularly in the presence of bone metastasis. There have been only a few reports in lung cancer and associated radiographic findings have seldom been described. 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 and thoracic spine showed marked hyperostosis, with sizes larger than the original bone structure, suggesting efficacy of gefitinib. The significance of such hyperostosis should be elucidated.

Alkaline phosphatase flare with hyperostosis of bone metastases in lung adenocarcinoma treated with gefitinib