First-Line Lorlatinib for ALK-Rearranged Pulmonary Large-Cell Neuroendocrine Carcinoma with Brain Metastases and Suspected Leptomeningeal Involvement: A Case Report and Literature Review.

Authors

Yoshio Nakano, Kazuya Nishimura, Hiroka Serizawa, Yusuke Kuze, Gen Masuda, Norio Okamoto, Iwao Gohma, Yumiko Yasuhara

Published in

Internal medicine (Tokyo, Japan). Aug 19, 2026. Epub Aug 19, 2026.

Abstract

We report a case of ALK-rearranged pulmonary large-cell neuroendocrine carcinoma (LCNEC) with brain metastases and radiologically suspected leptomeningeal involvement, successfully treated with first-line lorlatinib. A 58-year-old woman was diagnosed with LCNEC, and molecular testing revealed an EML4-ALK fusion. Lorlatinib achieved a partial response, with regression of the primary lesion, brain metastases, and suspected leptomeningeal lesions. Our literature review showed that ALK-positive LCNEC occurs more often in younger, female, and never- or light-smoking patients. In such cases, molecular testing should be actively pursued. In LCNEC harboring actionable driver alterations, molecularly guided treatment, as used for NSCLC, may be a reasonable option.

PMID:
42618269
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.

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