Newly Diagnosed ALK+ Non–Small Cell Lung Cancer

August 21, 2020
Stephen Liu, MD

Medstar Georgetown University Hospital’s Dr Stephen Liu shares impressions on the way a 57-year-old man with ALK-positive metastatic non–small cell lung cancer was managed, highlighting the rationale for using a second-generation ALK inhibitor as treatment.


Case: A 57-Year-Old Man with ALK+ NSCLC

Initial Presentation

  • A 57-year-old man presented with fatigue, anorexia and occasional rib pain
  • PMH: unremarkable
  • PE: mild right-sided chest tenderness on palpation

Clinical Workup

  • Labs: WNL
  • Imaging:
    • Chest x-ray showed 3 right upper lobe masses
    • Chest/abdomen/pelvic CT scan confirmed 3 masses (largest 7.3 cm)
    • PET scan showed activity in the right upper lobe masses
    • MRI of the brain showed widespread scatter small lesions; consistent with brain metastases
  • Bronchoscopy with transbronchial biopsy of the right upper lobe confirmed lung adenocarcinoma
  • Molecular testing: EML4-ALK fusion+, EGFR-, ROS1-, BRAF-, KRAS-, NTRK-, MET-, RET-, PD-L1 100%
  • Staging: IVA adenocarcinoma; ECOG PS 0

Treatment

  • Patient was started on brigatinib 90 mg qDay for 7 days; well tolerated; dose was increased to 180 mg qDay