Unilateral cystic and bullous lung changes in a patient treated with brigatinib: a case report

Approximately 3% to 5% of individuals with oncogenic rearrangements in the anaplastic lymphoma kinase (ALK) gene develop non-small cell lung cancer (NSCLC). Brigatinib, a potent next-generation ALK tyrosine kinase inhibitor (TKI), has demonstrated significant systemic and intracranial responses, as well as improved progression-free survival, with an acceptable safety profile. According to European Society for Medical Oncology guidelines patients with ALK translocation and performance status 0-3 can be offered 1st line treatment with TKI (brigatinib, alectinib, or lorlatinib). To our knowledge, this is the first reported case of cystic or bullous changes in the lungs following incremental dosing of brigatinib. Here, we describe a 37-year-old male, a never-smoker, who developed progressively diffuse cystic changes in the lung parenchyma while receiving brigatinib treatment for NSCLC with intrapulmonary metastases. Clinicians should remain vigilant for this potential atypical pulmonary adverse effect, including the possibility of cystic or bullous transformations in the lung parenchyma.