Targeted Therapy with Alectinib in Anaplastic Lymphoma Kinase Positive Metastatic Pulmonary Adenocarcinoma - A Case Report

A 57 year old female patient with metastatic pulmonary adenocarcinoma presented with complaints of breathlessness, cough and chest discomfort. Whole Body FDG PET-CT Scan showed metabolically active primary right lung malignancy with metastasis to lymph nodes, liver, bones and brain. CT Scan suggested disseminated malignancy with mediastinal, supraclavicular, paraaortic lymphadenopathy, hepatic and vertebral metastasis, moderate right pleural effusion and pericardial effusion also noted and primary carcinoma lung right lower lobe. Pleural fluid was positive for malignant cells. CT Guided Trucut Biopsy showed lung lesion. Immunohistochemistry (IHC) revealed that the disease was ROS I but ALK rearrangement positive and Mutation Analysis by Real Time Polymerase Chain Reaction confirmed the disease is EGFR-Wild type. She was initially on Docetaxel and Carboplatin, then changed to Alectinib considering the ALK(DSF3) positivity. She had improved considerably further after administration of Alectinib.