Dr Olazagasti on a Case-Based Discussion of ALK-Mutated NSCLC Treatment

Coral Olazagasti, MD, assistant professor, Clinical Medical Oncology, Department of Medicine, Division of Medical Oncology, Sylvester Cancer Center, University of Miami Miller School of Medicine, discusses her participation in a case-based discussion at the 21st Annual Winter Lung Cancer Conference®, and the importance of having conversations such as these.

During the event, Olazagasti presented a case study of a patient with non–small cell lung cancer (NSCLC) harboring an ALK alteration. The patient initially had an unconventional clinical presentation that appeared to be primary thyroid disease but was ultimately diagnosed as lung adenocarcinoma, she details. PET/CT scans revealed FDG avid lymph nodes in the neck, cheek and abdomen that signaled a potential malignancy, along with diffuse FDG uptake in the thyroid gland, peribronchial thickening. The patient's immunoprofile favored the lung as the origin of disease.

After undergoing next-generation sequencing, the patient was identified as harboring an ALK mutation and treated with 600 mg of alectinib (Alecensa) every 12 hours. The patient initially achieved a complete response on initial PET scan, but later began experiencing cervical lymph nodes. A follow-up scan demonstrated signs of disease recurrence, and the patient was switched to lorlatinib (Lorbrena). Carboplatin/pemetrexed was then added to this regimen, and improvements in response were observed. The patient is currently on maintenance pemetrexed and lorlatinib.

The presentation prompted a thorough discussion among colleagues, where varying perspectives were evaluated and different treatment options were explored, Olazagasti says. The interactive nature of the case presentation allowed for a collaborative exchange of ideas and insights from the audience, she adds. Colleagues provided valuable feedback and suggestions, including key considerations if the patient's disease transformed into a squamous cell presentation, and the importance of repeating biopsies or adjusting treatment accordingly, Olazagasti details.

The experience underscored the dynamic and nuanced nature of medicine, where clear guidelines may not always apply to atypical presentations, Olazagasti continues. Engaging in discussions with peers and considering alternative viewpoints ensures comprehensive patient care and enables clinicians to adapt their approach based on individual patient needs, she emphasizes.

Ultimately, the case presentation served as a reminder of the importance of interdisciplinary collaboration and ongoing learning in delivering optimal patient care, Olazagasti says. By continuously seeking feedback and staying informed about the latest studies and trials, clinicians can ensure that they are providing the best possible treatment options for their patients, Olazagasti concludes.