A case of remarkable response to atezolizumab in ALK-translocated metastatic lung adenocarcinoma

The development of resistance to tyrosine kinase inhibitors (TKIs) in metastatic non-small cell lung cancer (NSCLC) with oncogenic driver mutations highlights the challenge in improving the survival of these patients. The standard of care for ALK-rearranged advanced NSCLC refractory to various generations of ALK TKIs falls back to the use of chemotherapy and the prognosis remains poor. We report the case of a 41-year-old lady with an ALK-translocated metastatic lung adenocarcinoma, who demonstrated good response to an immune checkpoint inhibitor, atezolizumab in combination with bevacizumab and chemotherapy (pemetrexed and carboplatin), following disease progression on three generations of ALK TKIs. Six months into treatment, she continues to show improvement in her health-related quality of life and is tolerating treatment well. Our case suggests that this treatment regimen is a potential treatment option for TKI-refractory driver-mutated NSCLC. •Treatment options for ALK-positive advanced lung cancer refractory to ALK tyrosine kinase inhibitors are limited.•Atezolizumab combination therapy is a promising therapeutic strategy for ALK-positive advanced lung cancer.•The potential of an atezolizumab combination therapy may be realized with tolerable treatment-related toxicities.