Abstract
Anaplastic lymphoma kinase tyrosine kinase inhibitors (ALK TKIs) show robust activity in patients with non-small-cell lung cancer (NSCLC) harboring an ALK-rearrangement. Rare but serious side effects, such as pneumonitis can occur with ALK TKIs. We here report a case of a patient with NSCLC with echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4- ALK) translocation who tolerated brigatinib following alectinib-induced pneumonitis. The patient was notable for diffuse ground-glass opacities 2 months after of initiating alectinib without dyspnea and hypoxemia. With no alternative etiology of pneumonitis identified, the patient was treated with corticosteroids and discontinuation of alectinib. Following rapid clinical recovery and radiographic resolution of the opacities, the patient was started with brigatinib, with no recurrence of the clinical symptoms or radiographic findings of pneumonitis. While further descriptions are needed, our experience suggests that switching to a second ALK-TKI such as brigatinib may be a safe therapeutic option in some patients who develop drug-induced pneumonitis on alectinib.