Clinical Case: ALK-Positive Advanced NSCLC
Panelists discuss how a 48-year-old fitness instructor with ALK-rearranged stage IV lung cancer and bone metastases was successfully treated with alectinib, experiencing manageable adverse effects while returning to modified teaching activities.
This segment presents a comprehensive case study of a 48-year-old fitness instructor diagnosed with stage IV ALK-rearranged non–small cell lung cancer (NSCLC), illustrating the unique presentation and management considerations for ALK-positive disease. The patient presented with persistent hip pain and progressive shortness of breath over several months, symptoms initially attributed to occupational overuse and respiratory infection. This case highlights how ALK-positive lung cancer often presents in younger, nonsmoking patients with atypical symptoms that may delay diagnosis.
Advanced imaging revealed extensive disease, including a 4.2-cm right lower lobe mass, mediastinal lymphadenopathy measuring up to 1.5 cm, and multiple small lytic bone lesions in the pelvis and femur consistent with metastatic spread. The biopsy results confirmed lung adenocarcinoma, with next-generation sequencing identifying ALK rearrangement, which occurs in approximately 3% to 5% of NSCLC cases but represents a highly targetable oncogenic driver. The bone-predominant metastatic pattern is characteristic of ALK-positive disease and influences both prognosis and treatment monitoring strategies.
Treatment options presented to the patient included second-generation ALK inhibitors alectinib and brigatinib as well as lorlatinib, representing the current standard approaches for ALK-positive advanced NSCLC. The patient ultimately chose alectinib, experiencing manageable gastrointestinal adverse effects and intermittent myalgia that responded well to supportive care measures. The successful return to modified fitness instruction demonstrates the potential for maintaining quality of life and functional status with appropriate ALK inhibitor therapy, highlighting the importance of personalized treatment selection based on individual patient factors, adverse effect profiles, and lifestyle considerations.
