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Lung Cancer Case Studies

Case Studies: ALK-Translocated Non-Small Cell Lung Cancer With Bone Metastases

In this case-based interview, Corey J. Langer, MD, reviews the case of a patient with metastatic ALK-translocated NSCLC. Dr Langer highlights the options for treating the patient through progression based on recent research.

ALK-Translocated Non-Small Cell Lung Cancer With Bone Metastases

August 2016

  • A 51-year-old female presents to her physician with symptoms of fatigue, intermittent chest pain, and lower back pain
  • PMH: hypertension managed on a calcium channel blocker; osteoarthritis
  • No history of smoking
  • CT of the chest showed a 4.5-cm mass in the upper right lobe and enlarged hilar lymph nodes
  • Bronchoscopy and transbronchial lung biopsy were performed:
    • Pathology revealed a grade 2 adenocarcinoma, consistent with a lung primary tumor
    • Molecular testing:
      • FISH: positive for ALK translocation
      • NGS: negative for EGFR, ROS1, RET, BRAF, KRAS
      • IHC: PD-L1 expression in 0% of cells
    • Staging with PET/CT showed 18F-FDG uptake in the lung mass, hilar nodes, and lumbar spine (L4/L5)
    • Brain MRI, negative for intracranial metastases
  • The patient was started on therapy with crizotinib
  • Follow-up imaging at 3 and 6 months showed marked regression of the lung mass, nodal spread, and bone lesions

June 2017

  • After 9 months on crizotinib, the patient reported worsening fatigue and back pain
  • CT showed increased size of the pulmonary mass and bone lesions
  • Brain MRI showed disseminated small lesions
  • Crizotinib was discontinued and the patient was started on brigatinib
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