{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T15:28:26Z","timestamp":1776785306282,"version":"3.51.2"},"reference-count":17,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T00:00:00Z","timestamp":1620000000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Thoracic Cancer"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The incidence of central nervous system (CNS) metastases in patients with anaplastic lymphoma kinase (<jats:italic>ALK<\/jats:italic>) fusion gene\u2010positive (<jats:italic>ALK+<\/jats:italic>) non\u2010small cell lung cancer (NSCLC) is high, ranging from approximately 20%\u201370%. Although ALK inhibitors (ALKis) are generally effective for CNS metastases in patients with <jats:italic>ALK+<\/jats:italic> NSCLC, relapse with CNS metastases is frequently observed. A 37\u2010year\u2010old woman with a high level of carcinoembryonic antigen was diagnosed with right lung adenocarcinoma (pathological stage IIIA) and underwent right lower lobectomy. Despite the administration of postoperative chemotherapy, her carcinoembryonic antigen (CEA) level remained elevated. Although crizotinib was administered due to the positivity for <jats:italic>ALK<\/jats:italic> fusion, brain metastases appeared at 19.0\u00a0months after the start of treatment. Treatment with alectinib following crizotinib resulted in the complete disappearance of brain metastases. However, brain metastases relapsed, and meningeal dissemination appeared at 38.3\u00a0months after the start of treatment with alectinib. Although ceritinib, brigatinib, and alectinib rechallenge were attempted, the CNS lesions worsened. Lorlatinib was then administered, resulting in the normalization of the CEA level (4.5\u00a0ng\/ml) 4.1\u00a0months after the start of lorlatinib. The brain metastases and meningeal dissemination almost disappeared. The overall time from the start of crizotinib to lorlatinib is 89.5\u00a0months at present, and the patient continues to be treated with lorlatinib without relapse. Lorlatinib was effective in this case with brain metastases and meningeal dissemination after resistance to first\u2010 and second\u2010generation ALKis. Appropriate sequential treatment with first\u2010, second\u2010 and third\u2010generation ALKis can lead to a long\u2010term survival in <jats:italic>ALK+<\/jats:italic> patients with brain metastases and meningeal dissemination.<\/jats:p>","DOI":"10.1111\/1759-7714.13962","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T17:00:35Z","timestamp":1620061235000},"page":"1761-1764","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["<scp><i>ALK<\/i><\/scp>\u2010positive lung cancer in a patient with recurrent brain metastases and meningeal dissemination who achieved long\u2010term survival of more than seven years with sequential treatment of five <scp>ALK<\/scp>\u2010inhibitors: A case report"],"prefix":"10.1111","volume":"12","author":[{"given":"Keisuke","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Clinical Research Institute National 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