间变性淋巴瘤激酶 (ALK) 重排的非小细胞肺癌 (NSCLC) 中常见转移性扩散至中枢神经系统 (CNS)，对患者预后和生活质量具有重要影响。高达 10% 的 ALK 阳性 NSCLC 病例可能会发生软脑膜受累。 Lorlatinib 是第三代 ALK 抑制剂，具有出色的 CNS 渗透性，并在已接受治疗和未接受治疗的患者中均显示出疗效。在此，我们介绍了一名被诊断患有 IV 期 ALK 重排 NSCLC 的 34 岁患者的病例，该患者接受了两种 ALK 抑制剂（克唑替尼，随后是艾来替尼）和几个疗程的脑立体定向消融性放射治疗，直到检测到软脑膜受累。然后给予三线劳拉替尼，2 个月后，脑 MRI 记录软脑膜受累完全消退，36 个月后仍保持这种状态，同时劳拉替尼治疗仍在进行中，耐受性良好。据我们所知，这是文献中报道的较长颅内反应，强调了选择最合适的全身治疗及其与局部区域方法相结合以改善结果的重要性。版权所有 © 2024 Wolters Kluwer Health, Inc.版权所有。

Metastatic spread to the central nervous system (CNS) is frequent in anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC) and has an important impact on patient prognosis and quality of life. Leptomeningeal involvement may occur in up to 10% of cases of ALK-positive NSCLC. Lorlatinib is a third-generation ALK inhibitor that has excellent CNS penetrability and demonstrated its efficacy both in pretreated and treatment-naive patients. Herein, we present the case of a 34-year-old patient diagnosed with stage IV ALK-rearranged NSCLC who received two lines of ALK inhibitors (crizotinib followed by alectinib) and several courses of brain stereotactic ablative radiotherapy until leptomeningeal involvement was detected. Third-line lorlatinib was then administered, and 2 months later encephalic MRI documented complete regression of the leptomeningeal involvement that is still maintained after 36 months while treatment with lorlatinib is still ongoing with good tolerability. To the best of our knowledge, this is the longer intracranial response reported in the literature, underlining the importance of the most appropriate choice of systemic treatments and their integration with loco-regional approaches to improve outcomes.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.