Newly Diagnosed ALK+ Non–Small Cell Lung Cancer
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
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