A 35-year-old female with no prior medical or substance abuse history presented in March 2023 with persistent and unremitting bone pain. She was initially evaluated by an Orthopaedic surgeon, and an MRI of the spine revealed multiple lytic bone lesions suggestive of metastases, indicating stage IV disease.

She was referred to our center for further evaluation. A whole-body PET-CT conducted on 22 March 2023 showed a left hilar lung mass, multiple mediastinal lymph nodes, as well as liver and skeletal metastases. A percutaneous needle biopsy from the liver confirmed metastatic adenocarcinoma originating from a primary lung tumour.

The patient was started on palliative chemotherapy with pemetrexed and carboplatin, and a next-generation sequencing (NGS) assay was initiated on the biopsy specimen. The results revealed an EML4/ALK gene fusion as the driver mutation. Based on this finding, the patient was started on the ALK-inhibitor Lorlatinib at a dose of 100 mg once daily.

A follow-up PET-CT scan after three months showed a complete response of both the primary tumour and the liver metastases, with sclerosis of the bone metastases— a significant sign of healing. Her most recent scan, conducted in May 2025 after 26 months of therapy, showed that her disease remains in complete remission. She continues to be in good health, maintaining her pre-morbid lifestyle, and has not experienced any serious adverse events.

Dr. Shalabh Arora,

(Senior Consultant - Medical Oncologist at Ujala Cygnus Central Hospital, Haldwani)