Combined immune checkpoint inhibitor and chemotherapy is effective in a patient with ALK rearranged non-small cell lung cancer: a case report

Targeted therapies are validated to be efficient in non-small cell lung cancer (NSCLC) patients with driver gene mutations, but the emergence and development of immune checkpoint inhibitors (ICIs) in the last decades offers new insight into the therapeutic decisions of patients harboring driver gene mutations. The appropriate application of ICIs-based strategies in these patients remains to be assessed. Here, we present a patient with chest tightness and nonproductive cough. A primary site was found in left lower lobe with pleural effusion, pericardium effusion and multiple enlarged lymph nodes. He was diagnosed with advanced NSCLC and responded well to the first line pembrolizumab combined with pemetrexed and carboplatin with a progression free survival of 26 months. Immunohistochemistry analysis of relapsed 4R lymph node indicated ALK-positive. Surprisingly, identical form of ALK gene rearrangement was observed in re-biopsy sample and the specimen 2 years ago. The patient was again dramatically benefit from 2L alectinib. No adverse event was presented and the progression-free survival is not reached until this case report. Hence, the current case suggested that combined immunotherapy and chemotherapy might be an efficient and tolerable alternative at 1L or after resistance to standard of care in patients with oncogene mutant NSCLC. Further data is required to make this a practical ambition.