She was diagnosed with stage 4 lung cancer after it spread to her liver; a gene test and targeted therapy helped her live nearly a decade

A persistent cough that just won’t go away, coughing of blood, breathlessness or chest pain. This is how Stage 4 lung cancer may creep into your life. Stealthily, with no early symptoms, such that when it shows its full presence, it’s already too late.

But not all hope is lost because sometimes, a timely diagnosis can rewrite your story. It is crucial to identify driver mutations in lung cancer. Precision oncology has enabled us to move away from broad 'one-size-fits-all' treatments and deliver highly personalised medicines. There are now 10 different molecular subtypes in lung cancer, and it is imperative to search for these in every patient of stage IV adenocarcinoma lung.

NGS testing has become essential for all these patients and is now being done not only in tumor tissue, but also in blood.

Among the different types of driver mutations, ALK-positive lung cancer, with a incidence of about 5%, is considered one of the most responsive to targeted treatment. Initially Crizotinib was considered as first line treatment, but later Alectinib replaced Crizotinib as a better first line option.

But now, Loraltinib has shown exceptional results and has become an ideal first line treatment for ALK positive lung cancer.In 2017, a 56-year-old woman overlooked subtle signs and was diagnosed with Stage 4 lung cancer after it had already spread beyond the lungs to the lymph nodes and liver. The distraught woman was brought to hospital where she was evaluated, and after confirming biopsy to be adenocarcinoma lung, started her on 4 cycles of chemotherapy.

The treatment worked initially, and her symptoms subsided. However, this relief was temporary.

And the doctors who were treating her were aware of this.“As part of her diagnostic workup, we performed next generation sequencing (NGS) on her biopsy, which revealed a crucial finding. She had ALK-positive lung cancer, a subtype driven by the alteration of the Anaplastic Lymphoma Kinase (ALK) gene, and one that could effectively be treated with targeted therapy,” said Dr Amit Rauthan, HOD & Consultant - Medical Oncology, Immunotherapy and Precision Medicine, Manipal Hospital Old Airport Road.

“Without wasting a single moment, she was started on Crizotinib, a first generation ALK-targeted oral therapy, which was well tolerated and enabled her to maintain a good quality of life. In 2018, Crizotinib was considered a standard first line treatment for this disease.”For nearly a year, the disease remained under control. However, in 2019, the cancer again showed signs of progression. Around the same time, newer-generation ALK-targeted therapies had become available.

A new second generation ALK inhibitor called Alectinib and third generation ALK inhibitor called Lorlatinib had been just introduced in India. She was transitioned to treatment with Lorlatinib.To everyone’s relief, her body responded exceptionally well to the medication. Within a few weeks, her quality of life improved significantly, allowing her to return to normal life. She continues to be on Lorlatinib for the last 7 years.

Today, nearly a decade since her initial diagnosis of stage IV lung cancer, she continues to lead a very active and healthy life. This case is an example of how targeted therapy can help patients with even stage 4 lung cancer to achieve long-term survival, with good quality of life. As modern medicine continues to evolve, new, highly effective personalised therapies, backed by precision oncology, continue to enter the market.