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      A case of remarkable response to atezolizumab in ALK-translocated metastatic lung adenocarcinoma

      case-report

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          Abstract

          The development of resistance to tyrosine kinase inhibitors (TKIs) in metastatic non-small cell lung cancer (NSCLC) with oncogenic driver mutations highlights the challenge in improving the survival of these patients. The standard of care for ALK-rearranged advanced NSCLC refractory to various generations of ALK TKIs falls back to the use of chemotherapy and the prognosis remains poor. We report the case of a 41-year-old lady with an ALK-translocated metastatic lung adenocarcinoma, who demonstrated good response to an immune checkpoint inhibitor, atezolizumab in combination with bevacizumab and chemotherapy (pemetrexed and carboplatin), following disease progression on three generations of ALK TKIs. Six months into treatment, she continues to show improvement in her health-related quality of life and is tolerating treatment well. Our case suggests that this treatment regimen is a potential treatment option for TKI-refractory driver-mutated NSCLC.

          Highlights

          • Treatment options for ALK-positive advanced lung cancer refractory to ALK tyrosine kinase inhibitors are limited.

          • Atezolizumab combination therapy is a promising therapeutic strategy for ALK-positive advanced lung cancer.

          • The potential of an atezolizumab combination therapy may be realized with tolerable treatment-related toxicities.

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          Most cited references24

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          Nivolumab versus Docetaxel in Advanced Nonsquamous Non–Small-Cell Lung Cancer

          Nivolumab, a fully human IgG4 programmed death 1 (PD-1) immune-checkpoint-inhibitor antibody, disrupts PD-1-mediated signaling and may restore antitumor immunity.
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            Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial.

            Atezolizumab is a humanised antiprogrammed death-ligand 1 (PD-L1) monoclonal antibody that inhibits PD-L1 and programmed death-1 (PD-1) and PD-L1 and B7-1 interactions, reinvigorating anticancer immunity. We assessed its efficacy and safety versus docetaxel in previously treated patients with non-small-cell lung cancer.
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              Atezolizumab for First-Line Treatment of Metastatic Nonsquamous NSCLC

              The cancer-cell-killing property of atezolizumab may be enhanced by the blockade of vascular endothelial growth factor-mediated immunosuppression with bevacizumab. This open-label, phase 3 study evaluated atezolizumab plus bevacizumab plus chemotherapy in patients with metastatic nonsquamous non-small-cell lung cancer (NSCLC) who had not previously received chemotherapy.
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                Author and article information

                Contributors
                Journal
                Respir Med Case Rep
                Respir Med Case Rep
                Respiratory Medicine Case Reports
                Elsevier
                2213-0071
                13 July 2021
                2021
                13 July 2021
                : 34
                : 101478
                Affiliations
                [a ]Department of Clinical Oncology, First Floor Menara Timur, University of Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
                [b ]Faculty of Medicine, University of Malaya, Malaysia
                Author notes
                []Corresponding author. Department of Clinical Oncology, First Floor Menara Timur, University of Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia. evon@ 123456ummc.edu.my
                Article
                S2213-0071(21)00140-4 101478
                10.1016/j.rmcr.2021.101478
                8318922
                34336591
                cc21fcb0-77e0-44a0-b924-6c6e1d2579ff
                © 2021 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 15 March 2021
                : 4 July 2021
                : 11 July 2021
                Categories
                Case Report

                lung cancer,non-small cell,adenocarcinoma,atezolizumab,alk,immune checkpoint inhibitor,tki, tyrosine kinase inhibitor,nsclc, non-small cell lung cancer,ici, immune checkpoint inhibitor,alk, anaplastic lymphoma kinase,pd-1, programmed death-1,pdl-1, programmed death ligand-1

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