Case Report

Ten Years Survival in a Patient with Brain and Meningeal Metastases from ALK-Positive Lung Cancer Treated with Five Lines of Therapy: A Case Report

by Wanda Liguigli*, Roberto Barbieri, Rita Cengarle, Anita Rimanti, Giovanna Catania, Francesca Turina, Camilla Pesoni, Maurizio Cantore

Oncology Unit, Ospedale Carlo Poma, Strada Lago Paiolo, 10, 46100 Mantova, Italy

*Corresponding author: Wanda Liguigli, Oncology Unit, Ospedale Carlo Poma, Strada Lago Paiolo, 10, 46100 Mantova, Italy

Received Date: 24 February 2024

Accepted Date: 20 March 2024

Published Date: 25 March 2024

Citation: Liguigli W, Barbieri R, Cengarle R, Rimanti A, Catania G, et al (2024) Ten Years Survival in a Patient with Brain and Meningeal Metastases from ALK-Positive Lung Cancer Treated with Five Lines of Therapy: A Case Report. Ann Case Report. 9: 1711. https://doi.org/10.29011/2574-7754.101711

Abstract

Anaplastic lymphoma kinase (ALK) translocation is observed in 4–5% of lung adenocarcinoma patients. In October 2012, we diagnosed a translocated ALK lung adenocarcinoma with pleural and bone metastases in a 42-year-old woman. After 16 months of chemotherapy, due to progression of the abdominal lymph nodes, the patient started Crizotinib. After 28 months, brain MRI documented progression of brain disease and a CT scan showed lung progression. The patient underwent whole-brain radiotherapy and Ceritinib was started but discontinued after six months due to grade 3 gastrointestinal toxicity. In June 2017, progression of meningeal disease was documented and the patient started Brigatinib. After 41 months the brain CT scan showed multiple lesions and Lorlatinib was started. The patient is still continuing this therapy while maintaining a good quality of life. The advent of ALK inhibitors has changed the prognosis of these patients even in cases of cerebral and meningeal metastatic disease.

Keywords: Lung Cancer; ALK, Long-Term Survival; Brain and Meningeal Metastases

Introduction

The echinoderm microtubule-associated protein like-4-anaplastic lymphoma kinase (EML4-ALK) fusion gene is present in 4-5% of patients with metastatic Non-Small Cell Lung Cancer (NSCLC). The clinical characteristics most correlated with the presence of this fusion gene are: young age, adenocarcinoma histotype and non-smoking patient [1]. The presence of brain and meningeal metastases in NSCLC patients is associated with a worse prognosis and a shorter median survival compared to patients without brain disease [2]. The advent of ALK inhibitors, especially second and third-generation ones, has changed the prognosis of NSCLC patients even in cases of cerebral and meningeal metastatic disease [3,4]. We report the case of a long-term survivor patient treated with chemotherapy and four lines of ALK inhibitors.

 

Figure 1-3: MRI brain June 2017.