Remarkable Response to Iruplinalkib in an Elderly Patient with ALK-Positive Non-Small Cell Lung Cancer: A Case Report

Background: Anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) typically affects younger patients. Management in elderly patients with significant comorbidities presents unique diagnostic and therapeutic challenges. Data regarding the efficacy and safety of Iruplinalkib in elderly patients remain limited. Case Presentation: We report a 79-year-old male who presented with massive pleural effusion and multiple rib fractures. Initial diagnosis was established through pleural fluid cytology revealing adenocarcinoma. Following clinical stabilization, computed tomography (CT)-guided lung biopsy confirmed ALK-positive invasive adenocarcinoma. Treatment with Iruplinalkib 600 mg twice daily achieved a remarkable tumor response, with resolution of pleural effusion and significant reduction in tumor burden over 29 weeks. Treatment was well-tolerated, with only mild gastrointestinal adverse events. Conclusion: This case demonstrates that Iruplinalkib exhibits excellent efficacy and tolerability in elderly patients with ALK-positive NSCLC, even in those presenting with advanced disease and poor initial performance status. Age alone should not preclude consideration of targeted therapy when actionable driver mutations are identified.