Onkológia 6/2021

The effectiveness of second-generation ALK-TKIs in advance non-small cell lung cancer

Aim: The aim of the case report is to demonstrate the effectiveness of second-generation ALK-TKIs in patients with generalized lung adenocarcinoma with confirmed EML4-ALK rearrangement. Case report: We present the case of a 28-year-old patient in whom generalized adenocarcinoma of the lungs with extensive metastatic brain disease was confirmed in the 37th week of pregnancy after an urgent C-section for suspected eclampsia. Molecular genetic analysis of the tumor tissue confirmed the presence of ALK rearrangement, and alectinib treatment was initiated. After a month of treatment an excellent therapeutic response was found with a remarkable regression of CNS size, which was accompanied by a rapid remission of symptoms. After 11 months of treatment, systemic disease progression was noted while the intracranial response persisted. A change to a third-generation ALK-TKI is planned. Conclusion: Higher generations of ALK-TKI have a significantly better intracranial effect compared to the first generation. Good bloodbrain barrier penetration results in improved clinical status in patients with symptomatic metastatic brain disease.

Keywords: lung adenocarcinoma, ALK, pregnancy, brain metastatic disease, alectinib