Control of brain metastases with alectinib in anaplastic lymphoma kinase-rearranged lung cancer

Abstract

Brain metastasis from non-small cell lung cancer remains a challenge to physicians. It occurs in 30% of patients with advanced stage adenocarcinoma of lung and is often regarded as the ominous sign of disease progression and death. Alectinib is likely to be a promising agent, even after the failure of crizotinib and ceritinib, for patients with anaplastic lymphoma kinase (ALK) -driven non-small cell lung cancer with brain metastasis, resulting in a durable response for both intracranial and extra-cranial diseases. We report a young man who had ALK-driven adenocarcinoma of lung with progressive brain metastases despite targeted therapy and chemotherapy. Salvage treatment with alectinib resulted in durable response in both systemic and intra-cranial diseases. The rationale of therapeutic selection among various ALK tyrosine kinase inhibitors (TKI) is illustrated with this case in the era of personalized lung cancer treatment.