A Patient's Value for Quality of Life in Stage IV ALK-Rearranged Adenocarcinoma-Case 18 - A Patient's Value for Quality of Life in Stage IV ALK-Rearranged Adenocarcinoma PDF

Case 18 - A Patient's Value for Quality of Life in Stage IV ALK-Rearranged Adenocarcinoma PDF

Pdf Summary

This case study follows James Johnson, a 45-year-old man diagnosed with stage IV ALK-rearranged non-small cell lung cancer (NSCLC) presenting initially with a brain metastasis surgically resected. Despite a prior history of smoking and exposure to asbestos and secondhand smoke, his relatively young age and minimal smoking led to suspicion of driver mutations, confirmed by Next Generation Sequencing (NGS) detecting the EML4-ALK fusion.<br /><br />Initial imaging showed brain and systemic metastases including lymphadenopathy and bone lesions. Following surgery, guidelines recommend stereotactic radiosurgery (SRS) for solitary brain metastasis. For treatment, ALK inhibitors are standard first-line therapy in metastatic ALK-positive NSCLC. James chose Alectinib, favored for its efficacy and relatively milder side effect profile compared to other ALK inhibitors like Brigatinib or Lorlatinib, aligning with his priority on quality of life and family engagement.<br /><br />After four months on Alectinib, follow-up MRI and PET/CT scans demonstrated resolution of intrathoracic disease and bone lesions, with no recurrence in the brain and no significant treatment toxicity. This highlights the importance of balancing clinical efficacy against adverse events, given patients’ varying values and daily life considerations.<br /><br />Key learning points emphasize the necessity of early molecular profiling via NGS in suspected metastatic NSCLC cases, especially in younger patients with limited smoking history, to enable precision-targeted therapy. Equally critical is ongoing assessment of treatment response through imaging and clinical evaluation, combined with active patient involvement in decision-making to optimize adherence and manage side effects.<br /><br />In summary, this case underlines integrating genomic testing into initial workup, tailoring therapy to patient preferences to maintain quality of life, and continuous engagement to achieve optimal outcomes in ALK-positive metastatic NSCLC.

Keywords

ALK-rearranged NSCLC

brain metastasis

EML4-ALK fusion

Next Generation Sequencing

Alectinib

stereotactic radiosurgery

metastatic lung cancer treatment

precision-targeted therapy

treatment response monitoring

quality of life in cancer treatment