Successful use of enteric alectinib in a critically ill patient with metastatic ALK-adenocarcinoma: A case report.

Lung cancer is the most prevalent and the leading cause of cancer-related deaths worldwide, with approximately 40% of non-small cell lung cancer cases diagnosed at metastatic stages. Lung cancer patients frequently require intensive care, and while associated with significant mortality, initiating anti-cancer treatments during hospitalisation - particularly tyrosine kinase inhibitors (TKIs) - can improve outcomes due to their high efficacy and tolerability. We report a case of a young, non-smoker, treatment-naïve metastatic lung adenocarcinoma patient who presented with rapid respiratory decline. During admission, molecular testing confirmed the presence of Anaplastic lymphoma kinase rearrangement, and the patient began alectinib. During the stay in intensive care and following mechanical ventilation, alectinib was administered via nasogastric tube, achieving clinical improvement. The patient was discharged and sustained partial response was observed at six months. This highlights the potential for TKI therapy even in critically ill patients.