Primary Resistance to ALK Inhibitors in a Patient with Nonsmall Cell Lung Cancer with ALK Rearrangement: A Case Report with Review of Literature

Anaplastic lymphoma kinase inhibitors (ALKi) are the standard of care for metastatic ALK-rearranged nonsmall cell lung cancer (NSCLC). Though most patients respond well to ALK, seldom there are instances where the disease progresses rapidly. Here, we present a case of a 41-years-old male diagnosed as NSCLC with ALK rearrangement. Despite being started on first- and second-generation ALK-targeted therapy, he had rapid disease progression ultimately succumbing to the disease within 3 months of diagnosis. We suspect that our patient has a variant of ALK, making him resistant to both first- and second-line targeted therapy. Subjecting such nonresponders to next-generation sequencing and identifying the variants might help to recognize a subset of patients among ALK+ NSCLC who will need intense monitoring and early institution of other therapies for a better outcome.