Treatment Strategy of Lung Adenocarcinoma with Concomitant EGFR Mutation and ALK Rearrangement

Abstract Background The incidence of synchronous mutations of Epidermal growth factor receptor (EGFR) and anaplastic large-cell lymphoma kinase (ALK) rearrangements in non-small cell lung cancer (NSCLC) was low. Now clinical experience is still insufficient. Simultaneously the treatment of brain metastasis hemorrhage in the acute phase with lung cancer is still controversial. We described the clinical treatment strategy of a patient with synchronous mutations of EGFR and ALK. Methods The patient was a 55-year-old man with a mass in the right lower lobe. Pathological examination confirmed adenocarcinoma, tissue molecular examination showed EGFR exon 19 deletion, and ALK rearrangement. The patient received pemetrexed combined with cisplatin chemotherapy, gefitinib targeted therapy, clotriminib targeted therapy, albumin paclitaxel combined with nedaplatin and anlotinib therapy, and seretinib therapy. In the course of treatment, the patients had sudden tumor emergency, extensive hemorrhage and edema of brain metastasis, paralysis occurred in the patients. Subsequently, targeted therapy with ceritinib was given. After 1 month, lung tumors, brain metastases, and cerebral hemorrhage were all significantly improved. Results The tumor was well controlled. Progression-free survival (PFS)1 was 4 months, PFS2 was 3 months, PFS3 was 5 months, PFS4 was 5 months, and PFS5 was 9 months. At present, the patient still maintains partial response (PR) status. Conclusions Patients with simultaneous mutations choose the correct treatment strategy, which can significantly benefit the patients' PFS and quality of life. Especially for patients with acute hemorrhage of brain metastases, oral ceritinib may be an effective choice.