ONCAlert | Upfront Therapy for mRCC

Case Studies

Expert physicians provide insight on managing oncology-based patient cases that highlight the use of novel agents in clinical practice.
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Relapsed ALK-Rearranged NSCLC

Case: A 53-Year-Old Woman With ALK-Rearranged NSCLC

  • A 53-year-old woman presented with dyspnea, persistent cough with bloody sputum, and intermittent pain in right side of her chest
  • Relevant PMH:
    • Nonsmoker, had childhood exposure to second-hand smoke
    • No history or presence of pneumonia or bronchitis
    • No history of diabetes, cardiovascular disease, or renal disease
  • PE: lungs, clear; no palpable masses or visible lesions; patient is of average height and weight, appears physically fit
  • Diagnostic workup:
    • Chest X-Ray: revealed multiple small solid lesions in right lung
    • CT with contrast chest/abdomen/pelvis: several hyperattenuated tumors in right lung
    • Biopsy confirmed lung adenocarcinoma
    • Molecular testing:
      • Genetic testing; EGFR, BRAF, RET, KRAS, HER2 wild-type, ROS1 FISH
      • IHC; ALK-rearrangement
      • PD-L1 TPS; 20%
    • Brain MRI: revealed extensive CNS involvement
  • Treatment:
    • Started on alectinib; achieved partial response
    • Developed fatigue, grade 1 constipation, and nausea; continued treatment 
    • Imaging at 12 months showed disease progression
    • Tumor testing of a lung lesions demonstrated MET FISH+
  • She was started on crizotinib
    • Imaging at 3 and 6 months showed a partial response
    • Developed grade 2 diarrhea and visual disturbance; continued treatment
    • Imaging at 10 months showed progression in the CNS lesions and the lung
    • Repeat biopsy of the lung lesions and genotyping showed ALK L1196M mutation
  • She was started on brigatinib at 90 mg once daily; she tolerated therapy well and after 1 week, dose was increased to 180 mg once daily
    • Achieved partial response, including in CNS metastases
    • Had fatigue, but was able to resume some exercise
    • Remains on treatment 16 months later
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