Neuronal Biomarkers and Micronutrient Status in Adults with Mild Cognitive Impairment.

Oncogene-addicted lung cancer typically affects young patients without a history of tobacco exposure. In metastatic non-small cell lung cancers (NSCLC), molecular diagnosis is recommended for treatment decisions. Anaplastic lymphoma kinase ( gene fusions are observed in 3-6% of NSCLC () and are associated with increased tumor cell proliferation and survival properties. About 90 different fusion partners have been described for gene (), Echinoderm microtubule-associated protein-like 4 (EML4) gene fusions represent the most frequent rearrangement (accounting for 85% of rearrangements) (). These fusions confer sensitivity to ALK kinase inhibitors such as crizotinib, alectinib, ceritinib, brigatinib, lorlatinib or ensartinib (,). Treatment with alectinib has been associated with a prolonged progression-free survival (PFS) of 48.2 months in the first-line setting, establishing it as a recommended option (). However, based on the CROWN study, which reported a 60% PFS rate at 5 years, lorlatinib is now considered the preferred first-line treatment (). During anti-ALK treatment, acquired resistance mechanisms inevitably occur. Liquid biopsy represents an attractive and non-invasive alternative to tissue biopsy for resistance mutations identification or switch treatment (). Here, we report the case of a 36-year-old man with an -positive metastatic NSCLC, which develops six different mutations at progression after treatment with alectinib. A 36-year-old, never-smoker, Caucasian male presented to the emergency department of Nancy's university hospital in France (CHRU de Nancy) in September 2023, with symptoms of dyspnea, cough, and lateral thoracic pain persisting for five weeks. He had no significant medical history or treatment and was an active sportsman. There was no known exposure to asbestos.