Case Report: Severe brigatinib-induced pneumonitis in a patient with EML4–ALK+ metastatic non-small cell lung adenocarcinoma

• Published in: Frontiers in oncology Vol. 15; p. 1572425
• Main Authors: Dasika, Khyati Somayaji, Melody, Megan, Patel, Jyoti D.
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 24.04.2025
• Subjects: case report; NSCLC; Oncology; pneumonitis; steroids; tyrosine kinase inhibitor (TKI); case report; steroids; NSCLC; pneumonitis; tyrosine kinase inhibitor (TKI)
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2025.1572425

Anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs), such as brigatinib, are targeted therapies for metastatic non-small cell lung cancer (mNSCLC). We present a patient with echinoderm microtubule-associated protein-like 4 ( EML4 ) and ALK fusion protein-positive mNSCLC who developed severe hypoxemia and pneumonitis requiring intubation within 2 days of initiating brigatinib therapy. The workup for alternative etiologies of respiratory distress was unrevealing, and the patient was treated for presumed brigatinib-induced pneumonitis with high-dose methylprednisolone. This case demonstrates high-grade, rapidly progressive brigatinib-induced pneumonitis with prompt clinical improvement after steroids and a marked disease response without recurring toxicity after treatment with an alternative ALK TKI, alectinib.