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Lung Cancer Case Studies

Case Studies: Treatment Regimen for Patients With ALK+ Non-Small Cell Lung Cancer

In this case-based interview, Jonathan W. Riess, MD, MS, presents the case of a 69-year-old woman who needed a second ALK inhibitor to control non–small cell lung cancer that was uncontrolled on first-line treatment and discusses how to manage a patient like this.

Treatment Regimen for Patients With ALK+ Non-Small Cell Lung Cancer

CASE:  ALK+ Non–Small Cell Lung Cancer

March 2017

  • A 69-year-old female never-smoker presented with dyspnea, cough and fatigue
  • PMH: hypertension managed on losartan 100 mg
  • Chest X-ray showed multiple bilateral lung nodules
  • Brain MRI, negative for intracranial metastases
  • Bronchoscopy was performed with a fine needle aspirate biopsy 
    • Pathology revealed adenocarcinoma, consistent with a lung primary tumor
    • Molecular testing:
      • NGS: positive for ALK gene rearrangement
      • NGS: negative for EGFR, ROS1, RET, BRAF, KRAS
      • IHC: PD-L1 expression in 0% of cells
  • 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

January 2018

  • After 10 months on crizotinib, the patient reported worsening fatigue, back pain, and dyspnea
  • CT showed increased size of the pulmonary masses and bone lesions
  • Brain MRI showed disseminated small lesions
  • Crizotinib was discontinued and the patient was started on brigatinib
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