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case_images: Diagnoses of right lower lung adenocarcinoma, stage IV. (A) CT scan lung on Dec 17, 2019; (B) CT mediastinum on Dec 17, 2019; (C and D) PET-CT scan on Dec 31, 2019; (E) Histopathologic findings of lung adenocarcinoma of mediastinal lymph node from EBUS-TBNA (H&E, 40x). (F) Cytology from pleural effusion. Significant abnormal findings of right lung, lymph node and bone metastases were noted (arrow).
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case_images: His chest CT scan (Figure 1A and B) revealed a mass in the right lower lobe and right-side pleural effusion. PET-CT indicated a mass in the right lower hilar region with an elevated standardized uptake value (SUV) (Figure 1C), multiple lymph node enlargement, and bone metastases (Figure 1D). A diagnosis of lung adenocarcinoma was made on endobronchial ultrasound-guided transbronchial needle aspiration (TBNA-EBUS) of lymph nodes (Figure 1E). Lung adenocarcinoma cells were also found in pleural effusion samples (Figure 1F).
case_images: CT scans before and after ensartinib. (A) CT lung captured on May 6, 2020; (B) CT mediastinum on May 6, 2020; (C) CT lung on Aug 5, 2020 (before ensartinib); (D) CT mediastinum on Aug 5, 2020 (before ensartinib); (E) CT on Nov 30, 2020 (after ensartinib); (F) CT on Nov 30h, 2020 (after ensartinib). Significant abnormal findings of right lung were noted (arrow).
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case_images: Alectinib was given orally, at a dose of 600 mg twice daily from January 7, 2020, which resulted in partial response and patient continued to respond after four months of treatment (Figure 2A and B). Alectinib was, therefore, discontinued for more than two months when a chest CT scan on August 5, 2020 revealed enlargement of lung lesions (Figure 2C and D) and overall disease progression.
case_images: Bilirubin levels of this patient.
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case_images: The total bilirubin continuously decreased after two courses of ALSS (Figure 3).
case_images: Timeline of patient history.
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case_images: Tumors) criteria version 1.1. Toxicity of second-line ensartinib was grade 1 ALT and AST elevation and grade 1 skin rash, with no abnormality of bilirubin. The timeline of this patient is summarized in Figure 4.