July 5, 2018


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