ALK‑positive locally advanced lung cancer in a patient who achieved long‑term complete response with crizotinib: A case report

Abstract

In the last two decades, the existence of key oncogenic alterations, such as activating mutations or chromosomal reorganization, has become crucial in the advanced stage non-small cell lung cancer (NSCLC) treatment paradigm. Among these, anaplastic lymphoma kinase (ALK) gene rearrangement is reported in 3-7% of NSCLC cases worldwide. In patients who respond to long-term ALK therapy, treatment duration is uncertain. The present study reported a case of variant type 1 ALK-rearranged stage 3B lung adenocarcinoma that maintained a complete response for >6 years under treatment with crizotinib. As first-line treatment, crizotinib was administered twice daily (250 mg) and a complete response was confirmed after 3 months. After a complete response to crizotinib for 6 years, the treatment was stopped and the patient was followed up. Multiple brain metastases were detected during the third month of follow-up.

Keywords: anaplastic lymphoma kinase; crizotinib; long-term complete response; lung adenocarcinoma.

Figure 1

Radiological appearance at diagnosis, complete response and recurrence. PET-CT images of the diagnosis of (Aa) lung mass, (Ab) mediastinal lymph nodes and (Ac) scalene lymph nodes. PET-CT images showing complete response of (Ba) lung mass, (Bb) mediastinal lymph nodes and (Bc) scalene lymph nodes. PET-CT images of recurrent (Ca) lung mass, (Cb) mediastinal lymph nodes and (Cc) right supraclavicular lymph nodes. Brain magnetic resonance imaging at (Da) baseline and of (Db and Dc) multiple metastatic lesions on T1-weighted images. Yellow arrows indicate relevant radiological features. PET-CT, positron emission tomography-computed tomography.