Remarkable Clinical Response of ALK-Rearranged/TP53-Mutant Lung Adenocarcinoma with Liver Metastasis to Atezolizumab-Bevacizumab-Carboplatin-Paclitaxel After ALK Inhibitors: A Case Report

Abstract

Anaplastic lymphoma kinase-positive (ALK-positive) lung adenocarcinoma with multiple liver metastases accounts for a relatively small number of cases of non-small cell lung cancer. Several ALK-tyrosine kinase inhibitors (ALK-TKIs) are available for the treatment of lung cancer. However, there is limited evidence on the treatment of multiple liver metastases in patients with lung cancer that are refractory to ALK-TKIs. We report the case of a 42-year-old male patient with ALK-positive lung adenocarcinoma who experienced rapid progression to multiple liver metastases while receiving treatment with alectinib. Biopsy of the liver metastases revealed echinoderm microtubule-associated protein-like 4-ALK (EML4-ALK) fusion and tumor protein p53 (TP53) mutation; notably, ALK secondary mutations were not detected. Despite the sequential administration of third-generation ALK-TKIs, the liver metastases did not respond, the serum levels of total bilirubin and biliary enzymes continued to increase, and the patient’s general appearance worsened. Finally, the patient exhibited a remarkable clinical response to treatment with a combination of atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP). ABCP is one of the optimal options for ALK-positive lung cancer with liver metastasis that is refractory to ALK-TKIs therapy.

Keywords:

• lung adenocarcinoma
• anaplastic lymphoma kinase
• ALK
• liver metastasis
• ABCP
• TP53

Consent for Publication

Institutional approval was not required to publish the case details.

Written informed consent was provided by the patient for publication of this case report, including the patient’s details and accompanying images.

Disclosure

Dr Seike reported personal fees from Chugai, Takeda, and Pfizer. Dr Kubota reported personal fees from BMS, Chugai, Nihon Kayaku, Taiho, MSD and Pfizer outside the submitted work. Dr Miynaga reported honoraria from AstraZeneca, and Pfizer. Dr Tozuka reported honoraria from CHUGAI PHARMACEUTICAL CO., LTD and AstraZeneca K.K., outside the submitted work. There are no conflicts for other coauthors.