Mohammad Jahanzeb, MD:I’m Dr Mohammad Jahanzeb with Florida Precision Oncology, of 21st Century Oncology.
This was an interesting case of a 61-year-old white man who had never really smoked and presented with swelling above his left clavicle and shortness of breath. His examination was really remarkable for some wheezing in the chest. Otherwise, the case was fairly unremarkable. His laboratory data [were] also unremarkable. He had a biopsy of his left supraclavicular lymph node, which showed adenocarcinoma of the lung. Then he had an additional biopsy of the liver, because a CT [computed tomography] scan of his chest, abdomen, and pelvis showed evidence of liver metastases.
Interestingly, when molecular studies were sent, the patient had anALKrearrangement. None of the other mutations were found. His PD-L1 [programmed death-ligand 1] was 0%. To complete his staging work-up, he had an MRI [magnetic resonance imaging] of the brain, which showed multiple brain metastases.
When you think of this patient, what’s a little unusual is that his age is slightly above what we expect for anALK-positive patient. That’s a bit of an unusual feature. Otherwise, it’s very common to have brain metastases. It’s common to be metastatic at the onset, at the time of diagnosis. This is a fairly aggressive disease that has a predilection for brain metastases.
In this case, we chose to give him alectinib, which is FDA approved for first-line use besides some others that we can talk about later. The patient developed some toxicities on alectinib, specifically myalgias. The [dosage] had to be reduced from 600 mg down to 450 mg a day. The toxicity was maintained at about a grade 2 level. Ultimately, we had to follow him with imaging, and he progressed after 9 months.
Transcript edited for clarity.
Case: A 61-Year-Old Man WithALK-Rearranged NSCLC