ALK-Positive Lung Cancer: A Manado Patient’s Response After Three Months
A 70-year-old gentleman travelled from Manado, Indonesia, to see me with a cough and shortness of breath. He was an active smoker. Our investigations confirmed adenocarcinoma of the lung.
ALK-Positive Lung Cancer: Why Molecular Testing Matters
We arranged next-generation sequencing (NGS) to understand the molecular characteristics of his cancer. The results identified an ALK alteration, making this an ALK-positive lung cancer.
This finding helped us choose an appropriate targeted treatment. We started lorlatinib, an oral medicine that targets ALK-driven cancer.
ALK alterations are found in approximately 5% of non-small cell lung cancers. Identifying this relatively uncommon driver can change the treatment options available to a patient.
A Marked Response After Three Months
After three months of therapy, his follow-up imaging showed a very good response. The tumours had shrunk markedly, with only minimal residual disease remaining on our clinical imaging assessment.
In each comparison, the left image is before treatment and the right image is after three months of therapy. The whole-body PET and cross-sectional PET/CT images illustrate the change.
We assess response using the full imaging study together with the patient’s clinical condition. PET tracer uptake can also occur in normal organs and in non-cancerous conditions, so colour or darkness alone does not determine whether an area is cancer.
A Smoking History Should Not Exclude Molecular Testing
This gentleman’s smoking history did not stop us from investigating the molecular profile of his tumour.
In lung adenocarcinoma, age and smoking history alone should not be used to rule out testing for actionable changes. A cancer’s appearance under the microscope is important, but its molecular characteristics can provide additional information that guides treatment.
What NGS Can—and Cannot—Tell Us
NGS examines multiple genes to look for changes that may help guide treatment. In this case, it identified an ALK alteration that supported the use of an ALK-targeted medicine.
NGS is not a guarantee that an effective targeted drug will be found. The result needs to be interpreted alongside the type and stage of cancer, the exact alteration, previous treatment and the patient’s overall health.
Comprehensive molecular testing is particularly important when planning treatment for advanced non-small cell lung cancer, especially adenocarcinoma. The testing approach should be discussed as part of each patient’s treatment plan.
Personalised Treatment and Continued Follow-Up
This case highlights why understanding the biology of a cancer matters: finding an actionable alteration can help us select a treatment that directly addresses a driver of that cancer.
His response after three months was encouraging. Minimal residual disease on imaging does not mean that treatment is finished or that the cancer is cured. We continue treatment assessment and follow-up according to his clinical needs.
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