Successful alectinib treatment for a mechanically ventilated patient with ALK-positive non-small cell lung cancer

Abstract

We report a 38-year-old man with poor performance status (PS) who was diagnosed as stage IV non-small cell lung cancer (NSCLC) harboring the echinoderm microtubule-associated protein like 4 (EML4)-anaplastic lymphoma kinase (ALK) fusion gene. Crizotinib, an ALK inhibitor, was administered after a temporary effect of combination cytotoxic chemotherapy. Chest computed tomography showed air space consolidations and diffuse ground glass opacities in the both lungs after 5 days of treatment with crizotinib, and the patient required mechanical ventilation due to respiratory deterioration. For tumor progression, crizotinib was switched to alectinib, the other ALK inhibitor, along with short-term corticosteroid therapy for the possibility of crizotinib-induced pneumonitis. After alectinib administration through a nasogastric tube, tumors regressed with weaning from mechanical ventilation. Safe and successful administration of alectinib through a nasogastric tube may be a therapeutic option for the ALK-positive NSCLC patient with poor PS who fails to take oral medications.