Stage IV ALK Non-Small Cell Lung Cancer: Suzanne's Patient Story

Patient Info: Suzanne, Female | Stage IV

Biomarkers: ALK mutation identified on tissue biopsy; blood biomarker test was negative

Metastatic Site: Not specified

Stage IV ALK-positive lung cancer was stable for almost 4 years on alectinib before progression in mid-2023; Suzanne moved to brigatinib and radiation and was working toward stability again.

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ALK-rearranged Stage IVA lung adenocarcinoma: partial response to pembrolizumab as eighth-line treatment

Patient Info: Anonymized, Male, 70+ | Stage IV

Biomarkers: ALK strongly positive by IHC 3+; ALK rearrangement confirmed by FISH; PD-L1 expression 95% by 22C3 immunostaining; CEA 2.3 ng/mL at diagnosis

Metastatic Site: brain

Nine months after pembrolizumab was started as eighth-line therapy, he maintained a partial response after prior progression on multiple ALK inhibitors and chemotherapies.

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Stage III lung adenocarcinoma: neoadjuvant brigatinib, surgery, no evidence of disease

Patient Info: Anonymized, Female, 50s | Stage III

Biomarkers: Specific molecular alteration not stated in case 1 raw text; treated with brigatinib

No evidence of disease on PET-CT and brain MRI 27 months after surgery while receiving adjuvant brigatinib 90 mg daily.

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Stage III EML4-ALK lung adenocarcinoma: brigatinib, surgery, no evidence of disease

Patient Info: Anonymized, Female, 40s | Stage III

Biomarkers: EML4-ALK fusion rearrangement

No evidence of disease on PET-CT, with no brain metastases on MRI, after 32 months of adjuvant brigatinib following response and surgery.

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Stage 4 ALK-positive lung cancer: remission on lorlatinib

Patient Info: Anonymized, Male, Under 40 | Stage IV

Biomarkers: ALK-positive rearrangement; TTF-1-positive

Metastatic Site: bilateral lungs, mediastinal lymph nodes, bone, liver,…

Metastatic ALK-positive lung adenocarcinoma remained in radiologic and clinical remission on lorlatinib after CNS progression on earlier ALK-directed therapy and stereotactic radiosurgery.

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ALK-positive lung cancer spreading to both breasts after years of targeted therapy

Patient Info: Anonymized, Male, 50s | Stage IV

Biomarkers: ALK-positive, ALK mutation

Metastatic Site: bilateral breasts

At age 51, about 10 years after his Stage IV diagnosis, he remained alive with stable disease 8 months after removal of bilateral breast metastases while continuing maintenance therapy.

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Stage IIIA ALK-rearranged NSCLC: pathologic complete response to neoadjuvant brigatinib

Patient Info: Anonymized, Male, Under 40 | Stage III

Biomarkers: ALK gene rearrangement; CEA 8.49 ng/mL

He remained disease-free during 13 months of follow-up after neoadjuvant brigatinib reduced Stage IIIA ALK-rearranged NSCLC and curative-intent surgery showed pathologic complete response.

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ALK-positive lung adenocarcinoma with a brain metastasis responding completely to brigatinib

Patient Info: Anonymized, male | Stage IV

Biomarkers: EML4-ALK fusion positive

Metastatic Site: pleura, brain

More than 10 years after the original lung-cancer surgery, switching from crizotinib to brigatinib produced a complete response in the brain metastasis, with ongoing treatment.

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ALK-positive lung adenocarcinoma with a large brain metastasis responding to brigatinib

Patient Info: Anonymized, female | Stage IV

Biomarkers: ALK-positive

Metastatic Site: brain

The approximately 70 mm brain metastasis shrank dramatically within 2 to 5 weeks of brigatinib, allowing transition back to outpatient care.

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