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(Slides)

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Pdf Summary

A 67-year-old woman with metastatic lung adenocarcinoma harboring EGFR ex19del mutation and TP53 variants was initially treated with Osimertinib. After disease progression, a tumor re-biopsy did not reveal any druggable resistance mechanisms, so Osimertinib was continued with Carboplatin/Pemetrexed and palliative irradiation. The patient experienced remission but eventually progressed again and deteriorated to PS 2 with elevated LDH levels. A re-biopsy from the liver detected amplification of EGFR, KRAS, and CDK6 genes, as well as an EML4-ALK fusion. The patient then initiated Brigatinib, an ALK-TKI, in combination with reduced-dose Osimertinib. A PET/CT scan after four weeks showed stable disease, but the patient's condition rapidly deteriorated and treatment was discontinued. The patient passed away shortly after. The acquired EML4-ALK fusion is a rare mechanism of Osimertinib resistance but can be targeted effectively by combining EGFR- and ALK-TKIs. This case highlights the value of tumor re-biopsies in identifying further treatment options, even in heavily pretreated and fragile patients.

Asset Subtitle

Edyta Urbanska

Meta Tag

Speaker Edyta Urbanska

Topic Metastatic NSCLC: Targeted Therapy - EGFR/HER2

Keywords

metastatic lung adenocarcinoma

EGFR ex19del mutation

Osimertinib

Carboplatin

Pemetrexed

palliative irradiation

EML4-ALK fusion

Brigatinib

tumor re-biopsies

Osimertinib resistance