YO26 - The efficacy and safety of aumolertinib plus alectinib in NSCLC patients haboring EGFR 19 Del and ALK fusion co-mutations: a case report

Case summary

Background: Aumolertinib is a third-generation epidermal growth factor receptor- tyrosine kinase inhibitor (EGFR-TKI) that potently and selectively inhibits EGFR sensitizing and EGFR T790M resistance mutations. Alectinib is a second-generation anaplastic lymphoma kinase inhibitor (ALK-TKI) that potently and selectively inhibits ALK fusion mutations. In the previous studys, aumolertinib show the outcomes in patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) harboring EGFR mutations with co-mutations. Herein, we report a long term survival case by aumolertinib plus alectinib in NSCLC patients with EGFR 19Del and ALK fusion co-mutations

Methods: A 56-year-old female, The diagnosis indicated Stage IV(T4N1M1) lung adenocarcinoma with lymph node metastasis, pulmonary metastasis and pleural metastasis. Head-enhanced MRI and whole-body bone scan showed no abnormalities. Gene sequencing result showed a point mutation at exon 19(19 Del) and ALK fusion.

Reslults: In August 5, 2021, the patient received aumolertinib 110 mg QD as first-line targeted therapy, after 11 months, adding alectinib 600 mg BID at the first 2 months, then alectinib reduced to 600 mg QD due to knee joint pain. Four months later, a follow-up chest CT showed an irregular soft tissue mass adjacent to the right upper lobe and mediastinum, approximately 62mm×46mm, with clear borders and partial bronchial obstruction in the right upper lobe. The patient has undergone two chest CT scans at our hospital on July 27, 2021, and July 27, 2023. Comparing the two results, the overall disease control of the patient is satisfactory, the primary lesion reached partial response(PR). However, in the past six months, an external CT scan showed an increasing trend in the size of the primary lesion, but the report and CT images are not available. In August 1, 2023, the patient underwent EBUS-TBNA and genetic mutation retesting. The patient is currently still received aumolertinib puls alectinib therapy and under follow-up.

Conclusions: This case proved aumolertinib puls alectinib may be a good choice for EGFR 19Del and ALK fusion co-mutation NSCLC patients.

Clinical trial identification

Editorial acknowledgement