Updated phase 2 data showed a 60% ORR and 86% CNS ORR with frontline silevertinib in non-classical EGFR-mutant NSCLC; FDA discussion supported a phase 3 trial in 2027.
|Videos|August 22, 2019
A 61-Year-Old Man With ALK-Rearranged NSCLC
A 61-Year-Old Man With ALK-Rearranged NSCLC
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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
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