A 68-Year-Old Woman with ALK+ Non–Small Cell Lung Cancer
Karen Reckamp, MD, comments on the management and treatment of a 68-year-old woman with ALK+ NSCLC, as well as data demonstrated in the ALTA-1L trial, use of brigatinib, and her own clinical experiences.
Case: A 68-Year-Old Woman with ALK+ Non–Small Cell Lung Cancer
Initial presentation
- A 68-year-old woman presented with fatigue, wheezing and decreased appetite
- PMH: unremarkable
- PE: wheezing on auscultation; ECOS PS 1
Clinical Workup
- Labs: WNL
- Chest x-ray showed a left lower lobe mass
- Chest/abdomen/pelvic CT scan confirmed a 6.8-cm left lower lobe lung mass and a suspicious liver lesion
- PET scan showed activity in the left lower lobe mass and liver
- MRI of the brain showed several subcentimeter lesions without edema
- Bronchoscopy with transbronchial biopsy of the left lower lobe mass confirmed lung adenocarcinoma
- Molecular testing: NGS revealed EML4/ALK fusion+, EGFR-, ROS1-, BRAF-, KRAS-, NTRK-, MET-, RET-, PD-L1 0% by IHC
- Staging: IVB adenocarcinoma
Treatment
- Patient was started on brigatinib 90 mg qDay for 7 days; well tolerated; dose was increased to 180 mg qDay
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