57-Year-Old Never-Smoker with Dyspnea
Tom, a 57-year-old never-smoker, presented complaining of coughing, dyspnea, and fatigue. Other than mild hypertension controlled with losartan 100 mg, Tom has no comorbidities.
A chest X-ray reveals a mass in the left lung. Biopsy of the nodule was positive for non-small cell lung cancer and was an adenocarcinoma. A brain MRI was negative metastatic lesions. Molecular testing revealed that Tom had 0% expression of PD-L1 and was negative for EGFR, ROS1, and BRAF but was positive for ALK gene rearrangement.
Tom began treatment with crizotinib. After ten months of crizotinib therapy, Tom’s symptoms escalated — increased fatigue, back pain, and worsening dyspnea.
CT scans showed that his pulmonary nodules were increasing in size, had experienced nodal spread, and had developed lesions in several vertebrae. A brain MRI now shows disseminated small lesions.
What other tyrosine kinase inhibitor options might benefit Tom?
Could other treatment options, including targeted radiation, be helpful for this patient?
Another option for rapidly progressive disease the IMPOWER-150 quadruple combo.
In addition to a new systemic therapy (either TKI or chemo), I would add bone-directed therapy.