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. 2015 Mar;6(2):216-9.
doi: 10.1111/1759-7714.12146. Epub 2015 Mar 2.

Poor response to gefitinib in lung adenocarcinoma with concomitant epidermal growth factor receptor mutation and anaplastic lymphoma kinase rearrangement

Jianya Zhou  1 , Jing Zheng  1 , Jing Zhao  2 , Yihong Sheng  1 , Wei Ding  2 , Jianying Zhou  1
Affiliations

Poor response to gefitinib in lung adenocarcinoma with concomitant epidermal growth factor receptor mutation and anaplastic lymphoma kinase rearrangement

Jianya Zhou et al. Thorac Cancer. 2015 Mar.

Abstract

A patient presenting with concomitant epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation is rare. We report a non-small cell lung cancer (NSCLC) patient with concomitant ALK rearrangement and exon 19 (E746-A750del) EGFR mutation. The ALK rearrangement was confirmed not only in the primary tumor biopsy specimen, but also in the pleural effusion cell block by reverse transcriptase-polymerase chain reaction (RT-PCR), Ventana ALK immunohistochemistry assay, and fluorescence in situ hybridization. No clinical benefit using chemotherapy or EGFR tyrosine kinase inhibitor gefitinib was obtained in this case.

Keywords: EGFR mutation; EML4–ALK; lung cancer; tyrosine kinase inhibitors.

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Figures

Figure 1
Figure 1
Computed tomography (CT) scan of chest revealed a 3.0 × 2.0 cm lobulated nodular lesion in the right upper lobe with multiple metastatic lesions on both sides; enlargement of hilar and mediastinal lymph nodes; and bilateral pleural effusion.
Figure 2
Figure 2
Computed tomography (CT) guided lung biopsy specimen presented as anaplastic lymphoma kinase (ALK) positive by: (a) Ventana immunohistochemistry (×200); (b) fluorescence in situ hybridization (FISH) (×1000); epidermal growth factor receptor (EGFR) gene mutation (Exon 19 E746-A750del) positive by (c) amplification refractory mutation system (ARMS) polymerase chain reaction (PCR); (d) pyrosequencing assay based on PCR.
Figure 3
Figure 3
Cell block specimen made from the pleural effusion presented as anaplastic lymphoma kinase (ALK) positive by: (a) Ventana immunohistochemistry; and (b) reverse transcription-polymerase chain reaction (RT-PCR). Epidermal growth factor receptor (EGFR) gene mutation negative by (c) amplification refractory mutation system (ARMS) polymerase chain reaction (PCR).
See this image and copyright information in PMC

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