A 61-Year-Old Man With ALK-Rearranged NSCLC

August 22, 2019

A 61-Year-Old Man With ALK-Rearranged NSCLC


Case: A 61-Year-Old Man WithALK-Rearranged NSCLC

  • A 61-year-old man presented with recent onset shortness of breath and swelling above left clavicle.
  • Relevant PMH:
    • Nonsmoker, no previous CV- or pulmonary-related complications
  • PE: Lungs, right-sided wheezing on auscultation; left supraclavicular lymphadenopathy, palpable
  • Diagnostic workup:
    • Labs: WNL
    • Lymph node biopsy showed adenocarcinoma
    • CT CAP showed a 2.5-cm solid pulmonary lesion in the left inferior lobe and multiple liver lesions
    • CT‐guided core needle biopsy of the lung lesion revealed lung adenocarcinoma
    • Molecular testing:
      • EGFR, BRAF, KRAS, MET, RET, NTRKwild-type
      • IHC;ALK-rearrangement
      • PD-L1 TPS, 0%
    • Contrast‐enhanced MRI of the head showed multiple brain metastases
  • Treatment:
    • Started on alectinib 600 mg BID; achieved a partial response including regression of CNS disease
    • Patient developed grade 3 myalgia; dose reduced to 450 mg BID, sustained at grade 2
  • Imaging at 9 months showed disease progression in the lung mass and liver; stable CNS disease
    • Lung biopsy, mutation analysis;ALKG1202R
  • He 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)
    • Partial response with significant shrinkage in lung, liver, and CNS lesions