What happened, in summary

A man in his mid-50s was diagnosed with a right lower-lobe lung adenocarcinoma that was initially considered Stage I. During surgery in 2012, pleural dissemination was found, showing that the disease was more advanced. The resected tumor carried an EML4-ALK fusion. He then remained on crizotinib for about 10 years. In 2022, imaging found a small, asymptomatic brain metastasis, with retrospective review suggesting it may have been visible several years earlier. Rather than using brain radiation, his targeted therapy was changed from crizotinib to brigatinib. The brain lesion shrank and ultimately achieved a complete response, and brigatinib was continued without a dose-limiting adverse event. This represents more than 10 years living with ALK-positive lung cancer from the original surgery, with renewed disease control after a late brain metastasis.