A 50-Year-Old Woman With ALK-Rearranged NSCLC

Case: A 50-Year-Old Woman WithALK-Rearranged NSCLC

• A 50-year-old woman first presented with symptoms of dyspnea, persistent cough with bloody sputum, and intermittent right-sided chest pain
• Relevant PMH:
  • Nonsmoker, had childhood exposure to second-hand smoke
  • No history or presence of pneumonia or bronchitis
  • No history of diabetes, cardiovascular disease, or renal disease
• Diagnostic workup:
  • CT of the chest showed right lung mass
  • Biopsy confirmed NSCLC (adenocarcinoma) in right lung
  • MRI showed scattered small brain lesions. Patient is asymptomatic
  • Molecular testing:
    • EGFR and KRASWT
    • IHC:ALK-rearrangement
• Treatment: started on crizotinib; achieved a confirmed partial response including CNS response
• At 12-month follow-up, disease progression seen in the right lung mass, with 2 new liver lesions and progression in the brain
  • Mutation analysis;ALK I1171Nresistance mutation
• She was started on brigatinib 90 mg once daily and tolerated the dose well; after 1 week, her dose was increased to 180 mg once daily (2 90-mg tablets)
  • Had some mild nausea and diarrhea, but continued treatment
  • Achieved partial response, including reduction in CNS and liver lesions
  • At 15-month follow-up, now with stable disease