Successful management of lung adenocarcinoma with ALK/EGFR co-alterations and PD-L1 over-expression by bevacizumab combined with chemotherapy

Anaplastic lymphoma kinase (ALK)/epidermal growth factor receptor (EGFR) co-alterations in adenocarcinomas are rare and no therapeutic consensus is reached. The potentially negative prognostic effects of programmed death-ligand 1 (PD-L1) expression on tyrosine kinase inhibitor (TKIs) efficacy further complicates the treatment options for patients with ALK/EGFR co-alterations and PD-L1 over-expression. We describe a case of advanced lung adenocarcinoma, harboring concurrent ALK/EGFR mutations and extremely high PD-L1 expression, that achieved sustained remission by the first-line treatment strategy of antiangiogenic therapy combined with chemotherapy. It is our firm conviction that the use anti-angiogenics should not have fallen out of favor in this era of targeted therapy and checkpoint inhibitors.

Automated summary

This case study highlights the significance of using antiangiogenic therapy combined with chemotherapy in achieving sustained remission in advanced lung adenocarcinoma patients with concurrent ALK/EGFR mutations and extremely high PD-L1 expression. The use of anti-angiogenics should not be underestimated in this era of targeted therapy and checkpoint inhibitors.