Treatment Regimen for Patients With ALK+ Non-Small Cell Lung Cancer
Treatment Regimen for Patients With ALK+ Non-Small Cell Lung Cancer
CASE:ALK+ NonSmall 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 forEGFR, 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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