Overcoming absolute dysphagia in a thirty-year-old patient with advanced anaplastic lymphoma kinase-positive non-small cell lung cancer: a case report.

BACKGROUND

Anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) accounts for approximately 3-7% of all NSCLCs and predominantly affects young, never-smoker patients. Lorlatinib, a third-generation ALK tyrosine kinase inhibitor (TKI), has demonstrated significant efficacy as first-line therapy. However, its exclusive oral formulation poses a challenge in patients with dysphagia.

CASE PRESENTATION: We report the case of a 30-year-old woman with metastatic ALK-positive NSCLC who presented with severe dysphagia due to bulky supraclavicular and laterocervical lymphadenopathy compressing the cervical oesophagus. Given the impossibility of swallowing, lorlatinib 100 mg daily was administered via a nasogastric tube after tablet crushing. Within days, rapid reduction of cervical lymph node swelling was observed, swallowing improved, and the patient resumed oral intake. Imaging performed two weeks later showed partial response; at six months, PET-CT demonstrated complete metabolic response.

DISCUSSION: This case supports the feasibility and effectiveness of lorlatinib administration via the enteral route in patients unable to swallow. Despite the lack of formal evidence for alternative formulations, pharmacokinetic data suggest adequate absorption.

CONCLUSION

Crushed lorlatinib administered through a nasogastric tube represents a practical and effective option for dysphagic patients with ALK-positive NSCLC requiring early target-directed therapy.