August 25, 2017


ALK-Rearranged NSCLC Progressing on Crizotinib

August 2016

  • A 59-year-old Caucasian male presented with symptoms of cough and dyspnea
  • PMH: hypertension managed on a calcium channel blocker; osteoarthritis
  • Former smoker, 10 pack-years
  • CT of the chest and abdomen revealed a 6.0 cm spiculated mass in the left lower lobe, a loculated pleural effusion in the right hemithorax, and diffuse liver nodules
  • Bronchoscopy and transbronchial lung biopsy revealed a poorly differentiated adenocarcinoma of the lung. Cytopathologic examination of pleural fluid was positive for malignancy
    • Molecular testing:
      • IHC: positive forALKgene rearrangement
      • NGS: negative forEGFR, ROS1, BRAF
      • IHC: PD-L1 expression in 0% of cells
    • PET/CT showed18F-FDG uptake in the left lung mass, right pleura, and liver
    • Brain MRI, negative for intracranial metastases
  • The patient was started on therapy with crizotinib
  • Imaging at 3 and 6 months showed continued shrinkage of the lung mass and liver lesions and resolution of pleural metastases
  • Imaging at 9 months showed a small increase (2 mm) in the lung mass

June 2017

  • After 13 months on crizotinib, the patient reported mild dyspnea and weight loss
  • CT of the chest and abdomen showed increased size of 1.5 cm in the pulmonary mass, several new small lesions in the right lower lobe (<1 cm), and 2 left-sided adrenal masses, measuring 3.0 cm and 3.2 cm
  • Brain MRI, negative for intracranial metastases