What happened, in summary

A man was diagnosed with Stage IV ALK-positive lung cancer at age 41. He first received cisplatin and pemetrexed, which kept the cancer stable for four months. He then joined a clinical trial of alectinib and achieved a clinical complete response lasting almost three years.

After the cancer progressed, testing identified an ALK L1196M resistance mutation. Over the following years he received several ALK-targeted drugs, including ceritinib, brigatinib and lorlatinib. By age 51, lorlatinib had stopped controlling the disease, and he switched to atezolizumab, bevacizumab, carboplatin and paclitaxel.

Breast changes initially thought to be gynecomastia later developed into firm masses behind both nipples. Biopsy showed that these were metastases from the lung cancer rather than new breast cancers. He underwent removal of both breast tumors, and testing found an additional ALK G1202R resistance mutation. He then continued maintenance atezolizumab and bevacizumab. Eight months after surgery, his disease remained stable. His course documents more than ten years living with Stage IV ALK-positive lung cancer.