2023 World Conference on Lung Cancer (Posters)-EP12.01. Brigatinib Restores Disease Control at Second Progression on Osimertinib in Metastatic EGFR ex19del Mutated NSCLC with Acquired EML4-ALK Fusion

EP12.01. Brigatinib Restores Disease Control at Second Progression on Osimertinib in Metastatic EGFR ex19del Mutated NSCLC with Acquired EML4-ALK Fusion - PDF(Abstract)

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Researchers at Copenhagen University Hospital presented a case report at the WCLC 2023 conference, highlighting the efficacy of targeted therapy in a patient with metastatic non-small cell lung cancer (NSCLC) who had acquired an EML4-ALK fusion. The patient, a 67-year-old woman, was initially diagnosed with EGFR ex19del mutated NSCLC and received first-line treatment with Osimertinib. After 9 months of disease control, she experienced disease progression and underwent a tumor rebiopsy, which did not reveal any new treatment options.<br /><br />Despite this, the patient continued Osimertinib in combination with Carboplatin/Pemetrexed and palliative irradiation. The disease went into remission, but after 3 months, the patient experienced new progression and deteriorated to performance status 2. A rebiopsy was performed, and it revealed acquired amplification of KRAS, EGFR, and CDK6 genes, as well as an EML4-ALK fusion (variant 5a). The patient was then started on ALK-TKI, Brigatinib, while continuing Osimertinib at a reduced dose. After four weeks of combination treatment, the patient's CT scan showed stable disease.<br /><br />The researchers concluded that the acquired EML4-ALK fusion is a rare mechanism of Osimertinib resistance. However, it provides an opportunity for effective and feasible therapy by combining EGFR- and ALK-TKIs. They emphasized the value of rebiopsies, even in heavily pretreated and fragile patients, in identifying new treatment options.

Asset Subtitle

Edyta Urbanska

Meta Tag

Speaker Edyta Urbanska

Topic Metastatic NSCLC: Targeted Therapy - EGFR/HER2

Keywords

Copenhagen University Hospital

WCLC 2023 conference

targeted therapy

metastatic non-small cell lung cancer

EML4-ALK fusion

Osimertinib

rebiopsy

KRAS amplification

EGFR amplification

ALK-TKI