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

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.