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Brigatinib Medication Case Study: Three-Year Treatment Record and Experience Sharing of ALK-Positive Lung Cancer Patient
I. Patient Basic Information
Mr. Zhang, 52 years old, a middle-level manager at a company, visited a local tertiary hospital in May 2023 due to persistent cough and chest tightness. Chest CT examination revealed an occupying lesion in the upper lobe of the right lung, approximately 3.5×4.2 cm in size, with enlarged mediastinal lymph nodes. Further bronchoscopic biopsy and genetic testing confirmed ALK-positive non-small cell lung cancer (Stage IV), with two brain metastasis lesions discovered simultaneously.
II. Treatment Decision Process
After diagnosis, Mr. Zhang and his family had in-depth communication with the attending physician. Considering the patient had brain metastases, the doctor particularly recommended second-generation ALK inhibitors with excellent brain penetration capability. After comparative analysis of multiple treatment options, Brigatinib was ultimately selected as the first-line treatment regimen.
Main reasons for choosing Brigatinib included:
On July 15, 2023, Mr. Zhang officially began taking Brigatinib.
III. Initial Medication Experience (Weeks 1-4)
Week 1: Stepwise Dose Escalation Phase
Following medical advice, Mr. Zhang started with 90mg once daily. The first 3 days felt good with no obvious discomfort. On day 5, mild nausea began with slightly decreased appetite. During the week 1 follow-up, he reported to the doctor, who recommended continued observation without dose adjustment for now.
Following medical advice, Mr. Zhang started with 90mg once daily. The first 3 days felt good with no obvious discomfort. On day 5, mild nausea began with slightly decreased appetite. During the week 1 follow-up, he reported to the doctor, who recommended continued observation without dose adjustment for now.
Week 2: Dose Increased to 180mg
From day 8, the dose increased to 180mg once daily. That evening, mild diarrhea occurred, 2-3 times daily, with slight fatigue. Mr. Zhang adjusted his diet independently, switching to light, easily digestible foods, avoiding greasy and spicy items. By day 3, diarrhea symptoms significantly improved.
From day 8, the dose increased to 180mg once daily. That evening, mild diarrhea occurred, 2-3 times daily, with slight fatigue. Mr. Zhang adjusted his diet independently, switching to light, easily digestible foods, avoiding greasy and spicy items. By day 3, diarrhea symptoms significantly improved.
Weeks 3-4: Adaptation Period
Gastrointestinal reactions like nausea and diarrhea gradually subsided. Mr. Zhang began noticing mild skin itching, mainly on arms and back, not affecting daily life. Blood pressure monitoring showed occasional elevation, reaching maximum 145/95mmHg. The doctor recommended regular home monitoring without antihypertensive medication for now.
Gastrointestinal reactions like nausea and diarrhea gradually subsided. Mr. Zhang began noticing mild skin itching, mainly on arms and back, not affecting daily life. Blood pressure monitoring showed occasional elevation, reaching maximum 145/95mmHg. The doctor recommended regular home monitoring without antihypertensive medication for now.
IV. Side Effect Management and Coping Strategies
1. Gastrointestinal Reaction Management
Mr. Zhang shared his coping experience:
Mr. Zhang shared his coping experience:
2. Skin Problem Management
After skin itching appeared, Mr. Zhang consulted the doctor and used gentle moisturizing lotion, avoiding hot water washing and excessive scratching. Symptoms resolved spontaneously after 2 weeks without additional medication.
After skin itching appeared, Mr. Zhang consulted the doctor and used gentle moisturizing lotion, avoiding hot water washing and excessive scratching. Symptoms resolved spontaneously after 2 weeks without additional medication.
3. Blood Pressure Monitoring
Purchased a home electronic blood pressure monitor, measuring and recording twice daily (morning and evening). After 3 months, blood pressure gradually stabilized around 130/85mmHg without medication intervention.
Purchased a home electronic blood pressure monitor, measuring and recording twice daily (morning and evening). After 3 months, blood pressure gradually stabilized around 130/85mmHg without medication intervention.
4. Regular Follow-up Examinations
Strictly followed medical advice for examinations:
Strictly followed medical advice for examinations:
V. Efficacy Evaluation and Changes
First Evaluation (3 Months Medication)
October 2023 chest CT and brain MRI showed:
October 2023 chest CT and brain MRI showed:
Doctor evaluated as Partial Response (PR), continuing original treatment regimen.
Second Evaluation (6 Months Medication)
January 2024 examination results showed:
January 2024 examination results showed:
Doctor evaluated as continued partial response, treatment effect ideal.
Third Evaluation (12 Months Medication)
July 2024 examination:
July 2024 examination:
Fourth Evaluation (24 Months Medication)
July 2025 examination:
July 2025 examination:
Fifth Evaluation (36 Months Medication)
March 2026 latest examination:
March 2026 latest examination:
VI. Quality of Life Changes
Work Aspect
After 6 months of medication, Mr. Zhang gradually returned to work. Initially adopted flexible work schedule, working 4-6 hours daily. After 1 year of medication, returned to full-time work but avoided excessive overtime and business trips. Currently, work ability basically recovered to pre-illness level.
After 6 months of medication, Mr. Zhang gradually returned to work. Initially adopted flexible work schedule, working 4-6 hours daily. After 1 year of medication, returned to full-time work but avoided excessive overtime and business trips. Currently, work ability basically recovered to pre-illness level.
Exercise and Physical Activity
Dietary Adjustments
Psychological Adjustment
Mr. Zhang expressed experiencing anxiety and fear during initial diagnosis. Gradually adjusted through the following methods:
Mr. Zhang expressed experiencing anxiety and fear during initial diagnosis. Gradually adjusted through the following methods:
VII. Challenges Encountered and Solutions
Challenge 1: Medication Cost Pressure
Long-term Brigatinib medication costs were relatively high. Mr. Zhang's family alleviated pressure through:
Long-term Brigatinib medication costs were relatively high. Mr. Zhang's family alleviated pressure through:
Challenge 2: Side Effect Fluctuations
In the 8th month of medication, Mr. Zhang experienced relatively obvious liver function abnormalities, with transaminases elevated to 3 times normal value. Management approach:
In the 8th month of medication, Mr. Zhang experienced relatively obvious liver function abnormalities, with transaminases elevated to 3 times normal value. Management approach:
Challenge 3: Cold Complications
In the 15th month of medication, Mr. Zhang caught a common cold with fever and cough. Management approach:
In the 15th month of medication, Mr. Zhang caught a common cold with fever and cough. Management approach:
VIII. Recommendations for Similar Patients
Based on three years of medication experience, Mr. Zhang summarized the following recommendations for other patients:
1. Strictly Follow Medical Advice
2. Emphasize Side Effect Monitoring
3. Maintain Regular Follow-up
4. Adjust Lifestyle
5. Seek Support
IX. Future Outlook
Mr. Zhang expressed that after three years of treatment, he is full of hope for the future:
X. Doctor's Commentary
Mr. Zhang's attending physician provided commentary on this case:
"Mr. Zhang is a typical successful case of ALK-positive lung cancer targeted therapy. Key factors for treatment success include:
This case fully demonstrates that ALK-positive lung cancer patients can achieve long-term disease control and obtain better quality of life through standardized targeted therapy. Hope more patients can gain confidence and inspiration from this."
XI. Summary
Mr. Zhang's three-year Brigatinib treatment case demonstrates the real journey of ALK-positive lung cancer targeted therapy. From anxiety at diagnosis to stability after treatment, from side effect troubles to effective management, every step reflects the importance of standardized treatment, scientific management, and positive mindset.
Targeted therapy is not a one-time solution, requiring joint efforts from patients, families, and medical teams. Through standardized medication, regular monitoring, lifestyle adjustments, and psychological support, ALK-positive lung cancer patients can completely achieve long-term survival and regain high-quality life.
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