Non-small cell lung carcinoma (NSCLC) is the major cause of
cancer-associated mortality. Identification of rearrangements in
anaplastic lymphoma kinase (ALK) gene is an effective instrument for more effective targeted
therapy of NSCLC using ALK inhibitors dramatically raising progression-free survival in the ALK-mutated group of patients. However, the
tumors frequently develop resistance to ALK inhibitors. We describe here a case of 48 y.o. male patient with ALK-positive NSCLC who was clinically managed for 6.5 years from the diagnosis. The
tumor was surgically resected, but 8 months later multiple
brain metastases were discovered. The patient started receiving
platinum-based
chemotherapy and then was enrolled in a clinical trial of second-generation ALK inhibitor
ceritinib, which resulted in a 21 months stabilization. Following disease relapse, the patient was successfully managed for 33 months with different lines of chemo- and local ablative
therapies.
Chemotherapy regimens, including off-label combination of
crizotinib +
bevacizumab +
docetaxel, were selected using the
cancer transcriptome data-guided bioinformatical decision support system Oncobox. These
therapies led to additional stabilization for 22 months. Survival of our patient after developing resistance to ALK inhibitor was longer for 16 months than previously reported average survival for such cases. This case shows that transcriptomic-guided sequential personalized prescription of targeted
therapies can be effective in terms of survival and quality of life in ALK-mutated NSCLC.