Ceritinib enables stereotactic radiosurgery to a previously untreatable symptomatic brain metastasis in a patient with ALK rearranged non-small cell lung cancer

Brain metastases are common in non-small cell lung cancer (NSCLC) and traditionally have been treated with whole brain radiation therapy, surgery, or stereotactic radiosurgery, with a limited role for systemic therapy. However, the development of highly active small molecule tyrosine kinase inhibitors for patients with NSCLC characterized by key driver mutations has generated interest in the use of systemic therapy as an alternative to potentially morbid local therapy for brain metastases. We present the case of a 59 year old Caucasian female with anaplastic lymphoma kinase (ALK) rearranged NSCLC who developed a large symptomatic brain metastasis not initially amenable to stereotactic radiosurgery (SRS) while receiving the ALK inhibitor crizotinib. The lesion regressed quickly after initiation of ceritinib, a next generation ALK inhibitor with known activity against crizotinib refractory ALK rearranged NSCLC, thereby allowing SRS as an alternative to standard craniotomy and consolidative whole brain radiation therapy.