A Case of ALK-rearranged Lung Cancer with a Durable Response to Atezolizumab Plus Bevacizumab/Carboplatin/Paclitaxel Combination Therapy After Initial Resistance to Alectinib

Abstract

━━ Background. In anaplastic lymphoma kinase (ALK)-rearranged lung cancer, ALK tyrosine kinase inhibitors have been reported to significantly prolong the progression free survival versus platinum-based combination therapy. In contrast, the effect of immune checkpoint inhibitors has been reported to be limited. We herein report a case of initial resistance to alectinib with a durable response to atezolizumab plus bevacizumab/carboplatin/paclitaxel combination therapy. Case. A 74-year-old woman with cough was referred to our hospital. She was diagnosed with ALK-rearranged lung adenocarcinoma cT4N3M1a stage IVA (PLE) and treated with alectinib. About two months later, the cancerous pleuritis and pericarditis worsened, and alectinib was continued after thoracic and pericardial drainage. Because cancerous pleuritis and pericarditis worsened even further, she was treated with atezolizumab plus bevacizumab/carboplatin/paclitaxel combination therapy. She subsequently obtained a long-term survival. Conclusion. In cases resistant to first-line ALK tyrosine kinase inhibitors, other ALK tyrosine kinase inhibitors are often considered, but combined immunotherapy may be effective in cases of initial resistance.