Case: A 53-Year-Old Woman WithALK-Rearranged NSCLC
- A 53-year-old woman presented with dyspnea, persistent cough with bloody sputum, and intermittent pain in right side of her chest
- Relevant PMH:
- Nonsmoker, had childhood exposure to second-hand smoke
- No history or presence of pneumonia or bronchitis
- No history of diabetes, cardiovascular disease, or renal disease
- PE: lungs, clear; no palpable masses or visible lesions; patient is of average height and weight, appears physically fit
- Diagnostic workup:
- Chest X-Ray: revealed multiple small solid lesions in right lung
- CT with contrast chest/abdomen/pelvis: several hyperattenuated tumors in right lung
- Biopsy confirmed lung adenocarcinoma
- Molecular testing:
- Genetic testing;EGFR, BRAF, RET,KRAS, HER2wild-type,ROS1FISH
- IHC;ALK-rearrangement
- PD-L1 TPS; 20%
- Brain MRI: revealed extensive CNS involvement
- Treatment:
- Started on alectinib; achieved partial response
- Developed fatigue, grade 1 constipation, and nausea; continued treatment
- Imaging at 12 months showed disease progression
- Tumor testing of a lung lesions demonstrated MET FISH+
- She was started on crizotinib
- Imaging at 3 and 6 months showed a partial response
- Developed grade 2 diarrhea and visual disturbance; continued treatment
- Imaging at 10 months showed progression in the CNS lesions and the lung
- Repeat biopsy of the lung lesions and genotyping showed ALK L1196M mutation
- She was started on brigatinib at 90 mg once daily; she tolerated therapy well and after 1 week, dose was increased to 180 mg once daily
- Achieved partial response, including in CNS metastases
- Had fatigue, but was able to resume some exercise
- Remains on treatment 16 months later