4CPS-118 Long-term survival in alk positive lung cancer: a case report

BackgroundLung cancer is the most common cancer worldwide as well as the leading cause of cancer-related deaths. Non-small cell lung cancer (NSCLC) accounts for up to 85% of all lung cancers. Multiple advances in the staging, diagnostic procedures and therapeutic options, as well as molecular knowledge have been achieved during the past years, although the overall outlook has not greatly changed for the majority of patients with the overall 5 year survival. Patients diagnosed with stage 4 NSCLC have poor survival rates (median 9–12 months).PurposeTo analyse and describe the clinical case of a long-term survival lung cancer patient.Material and methodsObservational retrospective clinical case. Data were obtained by review of the electronic medical records.ResultsA 46-years-old female followed by the oncology service for an advanced NSCLC anaplastic lymphoma kinase (ALK) positive EGFR wild-type. She received as first-line treatment crizotinib (250 mg, twice daily) from May 2013 until July 2015, when it was stopped by the disease’s progression, which was determined by imaging test. Crizotinib was well tolerated, and delays or interruptions were not necessary. In August 2015, she was involved in a clinical trial beginning treatment with AP26113 (brigatinib) 90 mg/24 hours 7 days and continuation with 180 mg/24 hours until June 2017, when it was interrupted by clinical progression. During this period, the drug was discontinued due to pneumonitis grade 1 (1–28 October 2015). She started treatment with lorlatinib (one daily 100 mg) until August 2017. In this period she suffered nail loss grade 1–2, with haemiparesis worsening and dysarthria increasing. In August, alectinib was authorised as a new line of treatment (fourth line). Currently, she continues with this treatment, presenting only dysgeusia grade 1.ConclusionActivating gene rearrangements in ALK have been identified as driver mutations in approximately 2% to 7% of patients with NSCLC. Although crizotinib is an effective treatment, some patients have a relatively short duration of response, and other patients fail to achieve a response. It is important to develop therapies that potentially can provide significant improvement in terms of treatment in ALK positive patients. In the case of this patient, there is a clear benefit of this type of therapy.Reference and/or Acknowledgements1. Clin Transl Oncol2015;17:1020–1029.No conflict of interest