What happened, in summary

A woman in her early 60s had completed chemoradiotherapy for Stage III ALK-positive lung adenocarcinoma. After being absent from regular follow-up, she returned with difficulty swallowing and worsening performance status. Imaging showed a very large brain metastasis measuring about 70 mm, together with right vocal-cord paralysis. Because brain biopsy was considered too risky and the clinical picture strongly supported spread from the ALK-positive lung cancer, the lesion was treated as metastatic disease. She and her family declined radiation therapy, and brigatinib was started as targeted treatment. Brain MRI after 2 and 5 weeks showed dramatic shrinkage of the metastatic tumor. A temporary rise in liver enzymes improved after a brief drug interruption, and brigatinib was continued without dose reduction. Her general condition improved enough for her to return to outpatient treatment.