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Case Reports
. 2022 Apr;13(7):1088-1090.
doi: 10.1111/1759-7714.14345. Epub 2022 Feb 24.

Response to ALK-TKIs in a lung adenocarcinoma patient harboring dual DCTN1-ALK and ALK-CLIP4 rearrangements

Fangfang Gao  1 , Fangfang Gao  2 , Huijuan Wu  1 , Junfeng Lu  1 , Yaping Xu  2 , Yanqiu Zhao  1
Affiliations
Case Reports

Response to ALK-TKIs in a lung adenocarcinoma patient harboring dual DCTN1-ALK and ALK-CLIP4 rearrangements

Fangfang Gao et al. Thorac Cancer. 2022 Apr.

Abstract

Rearrangements involving anaplastic lymphoma kinase (ALK) gene have been reported in ~5% of non-small-cell lung cancer patients. These rearrangements are characterized by the identification of various rare fusion partners, with unknown clinical significance. Specifically, the concurrence of different ALK fusions within the same patient, as well as its impact on therapeutic response to ALK tyrosine kinase inhibitors (ALK-TKIs), are rarely reported. Here, we report a 46-year-old female who was diagnosed with lung adenocarcinoma and identified carrying concurrent DCTN1-ALK and ALK-CLIP4 rearrangements by next generation sequencing (NGS) (638-gene panel). This patient showed partial response to crizotinib with a progress-free survival of 12 months and was then administered alectinib. Our report highlighted the importance of NGS testing in identifying rare ALK rearrangements and provided a novel insight into understanding the efficacy of ALK-TKI in this subset of patients.

Keywords: ALK rearrangement; lung cancer; targeted therapy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Immunohistochemistry (IHC) staining for ALK of lung tissue. (a) Integrative image of Formalin‐Fixed Paraffin‐Embedded (FFPE) tissue sample (left) and overview image of the sample using hematoxylin and eosin (HE) staining (right). (b) IHC staining for ALK. Strong positive staining for ALK in the left row and negative control staining in the right row
FIGURE 2
FIGURE 2
Subsequent chest CT scans. (a) Patient's CT scan at diagnosis, (b) 4 months after crizotinib treatment, (c) 12 months after initial crizotinib treatment, (d) 5 months after alectinib treatment. Red arrows indicate the tumor regions
FIGURE 3
FIGURE 3
Schematic illustration of DCTN1‐ALK and ALK‐CLIP4 gene rearrangement
See this image and copyright information in PMC

References

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