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Case Reports
. 2019 Aug:134:117-120.
doi: 10.1016/j.lungcan.2019.05.025. Epub 2019 Jun 6.

Transformation to neuroendocrine carcinoma as a resistance mechanism to lorlatinib

Niamh Coleman  1 , Andrew Wotherspoon  2 , Nadia Yousaf  3 , Sanjay Popat  4
Affiliations
Case Reports

Transformation to neuroendocrine carcinoma as a resistance mechanism to lorlatinib

Niamh Coleman et al. Lung Cancer. 2019 Aug.

Abstract

Objectives: Small cell transformation is a well-recognized mechanism of resistance to EGFR-TKI therapy in EGFR-mutant NSCLC, yet it remains a poorly-described phenomenon in ALK-rearranged NSCLC.

Material and methods: Chart and literature review.

Results: We report a case of a patient with ALK-rearranged lung cancer progressing on three-lines of ALK-targeted therapies, with development of acquired resistance to lorlatinib, with both transformation to a neuroendocrine carcinoma, and acquisition of ALK 1196 M.

Conclusions: Given the inevitable development of resistance in ALK + NSCLC, if feasible, re-biopsy on progression should be standard over liquid biopsy. Neuroendocrine carcinoma transformation remains an important mechanism of acquired resistance to lorlatinib.

Keywords: ALK positive; NSCLC; Neuroendocrine transformation; Oncogene addicted; Small cell lung cancer.

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