What happened, in summary

A 77-year-old woman was diagnosed with Stage IV ALK-positive lung adenocarcinoma after several weeks of shortness of breath led to imaging of a right hilar tumor, lung collapse and pleural effusion. She started alectinib. Within several weeks she developed severe hemolytic anemia, and alectinib was stopped while the cause was investigated. The tumor had already shrunk and her breathing had improved. When alectinib was restarted, laboratory signs of hemolysis returned. Because the cancer was responding, treatment continued on an intermittent schedule, with several weeks on alectinib followed by planned breaks and close blood-test monitoring. She needed one blood transfusion, but the anemia later became milder. At 1 year after starting treatment, the tumor had not regrown and alectinib remained part of her ongoing care.