case_images: PMC7411253_01
case_images: Schematics showing the patient's treatment history. (A) A diagram showing the chronological changes of therapeutic regimens and serum CEA levels during the entire course of treatment. RFA, radiofrequency ablation. (B-H) The patient's chest computed tomography (CT) scans at different clinical time points as shown. Arrowheads: location of the primary lung lesion in different scans. Arrows: paricardial effusion at initial diagnosis. PR, partial response; PD, progressed disease.
case_images: fonc-10-01259-g0001.jpg
case_images: PMC7411253_01_fonc-10-01259-g0001.jpg
case_images: F1
case_images: Chinese male with neither personal smoking history nor family medical history was diagnosed with stage IV lung adenocarcinoma with multiple metastases in cervical, hilar and mediastinal lymph nodes, and pericardial effusion in February 2016 (Figures 1A,B). Cervical lymph node biopsy was performed but not the primary lung tumor due to a number of reasons including the tumor size (1.5 cm by 1.5 cm), its proximity to the heart, and a large accumulation of pericardial effusion present at diagnosis. The patient soon received the first-line chemotherapy of six cycles of pemetrexed (500 mg/m2) and cisplatin (75 mg/m2) and achieved a partial response (PR) according to the RECIST guideline version 1.1 (Figure 1C). The patient demonstrated a progression-free survival (PFS) of about 20 months in total during the course of first-line chemotherapy until the disease progressed with the occurrence of bone metastases in October 2017, although the primary lung lesion remained stable (Figure 1D). The primary lung tumor demonstrated durable complete response to second-line chemotherapy (Figure 1E). However, serum CEA levels steadily increased and reached 105.4 mug/L by February 2019 (Figure 1A). Considering that there were few or no other treatment options, despite a low abundance of EML4-ALK fusion, we still determined to treat this patient with alectinib (600 mg twice daily) in March 2019 upon the diagnosis of multiple brain metastases by brain magnetic resonance imaging (MRI; Figures 1F, 2). CEA levels declined markedly (Figure 1A) following the treatment and a significant reduction in the size of brain lesions was also observed (Figure 2). After 3 months, metastatic brain tumors disappeared completely, while the primary lung lesion remained under control (Figure 1G) and CEA levels dropped to 2.2 mug/L (Figure 1A). The patient remained relapse-free during the entire follow-up period of about 13 months up till April 2020 (Figures 1H, 2).
case_images: Serial MRI scans showing patient's metastatic brain tumors responded completely to alectinib therapy. The patient achieved partial response (PR) 1 month after the initiation of alectinib therapy, and the lesions disappeared (CR) completely at the 3- and 13- month post-alectinib treatment time points. Arrows: metastatic brain tumors. CR, complete response.
case_images: fonc-10-01259-g0002.jpg
case_images: PMC7411253_01_fonc-10-01259-g0002.jpg
case_images: F2
case_images: Considering that there were few or no other treatment options, despite a low abundance of EML4-ALK fusion, we still determined to treat this patient with alectinib (600 mg twice daily) in March 2019 upon the diagnosis of multiple brain metastases by brain magnetic resonance imaging (MRI; Figures 1F, 2). CEA levels declined markedly (Figure 1A) following the treatment and a significant reduction in the size of brain lesions was also observed (Figure 2). The patient remained relapse-free during the entire follow-up period of about 13 months up till April 2020 (Figures 1H, 2).