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Tokat F, Zeren H, Barut P, Tansan S, Ince U. EML4-ALK-positive lung adenocarcinoma presenting an unusual metastatic pattern in a 29-year-old woman who is alive and well in her third year follow up:A case report. Respir Med Case Rep 2017; 22:117-122. [PMID: 28861332 PMCID: PMC5567651 DOI: 10.1016/j.rmcr.2017.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/16/2017] [Accepted: 07/18/2017] [Indexed: 12/17/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is a frequent tumor entity with high mortality. Although several newly discovered chromosomal translocations and mutations opened new horizons for targeted therapy, literature still lacks large series of NSCLC with chromosomal abberations and their correlations with histological and clinical features. We present a case of echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) translocation positive adenocarcinoma of the lung with an unusual metastatic pattern in a 29-year-old young woman. CONCLUSION Young adult non-smoker female patients with an unexplained pleural effusion and signs of metastatic disease should alert the physicians straight away for all types of malignancies including lung cancer. Any skin lesions should be evaluated carefully, biopsies should be done to exclude metastasis in urgency. On the other hand, an uncommon clinical presentation of a lung cancer requires corresponding molecular testing rapidly in order to offer the best treatment option.
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Affiliation(s)
- Fatma Tokat
- Pathology Department, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Handan Zeren
- Pathology Department, Acibadem University, Medical Faculty, İstanbul, Turkey
| | - Pinar Barut
- Pathology Department, Acibadem Maslak Hospital, Istanbul, Turkey
| | | | - Umit Ince
- Pathology Department, Acibadem University, Medical Faculty, İstanbul, Turkey
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Koinis F, Voutsina A, Kalikaki A, Koutsopoulos A, Lagoudaki E, Tsakalaki E, Dermitzaki EK, Kontopodis E, Pallis AG, Georgoulias V, Kotsakis A. Long-term clinical benefit from salvage EGFR tyrosine kinase inhibitors in advanced non-small-cell lung cancer patients with EGFR wild-type tumors. Clin Transl Oncol 2017. [DOI: 10.1007/s12094-017-1702-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Chien CR, Chen HJ. Lazarus response to treatment of patients with lung cancer and oncogenic mutations in the intensive care unit. J Thorac Dis 2016; 8:E1455-E1461. [PMID: 28066630 DOI: 10.21037/jtd.2016.11.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Novel targeted therapy for patients with non-small-cell lung cancer (NSCLC) and oncogenic mutations along with poor performance status (PS) sometimes evokes a "Lazarus" response. Moreover, for critically ill patients with NSCLC and respiratory failure requiring mechanical ventilation (MV) in the intensive care unit (ICU), only a few case reports have demonstrated positive outcomes with targeted therapy. This perspective review describes in detail the most recently published data in order to highlight the findings and the main pitfalls of targeted therapy for patients with NSCLC in the ICU.
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Affiliation(s)
- Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan;; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Jen Chen
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan;; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
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Bayliss R, Choi J, Fennell DA, Fry AM, Richards MW. Molecular mechanisms that underpin EML4-ALK driven cancers and their response to targeted drugs. Cell Mol Life Sci 2016; 73:1209-24. [PMID: 26755435 PMCID: PMC4761370 DOI: 10.1007/s00018-015-2117-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 12/14/2015] [Indexed: 02/05/2023]
Abstract
A fusion between the EML4 (echinoderm microtubule-associated protein-like) and ALK (anaplastic lymphoma kinase) genes was identified in non-small cell lung cancer (NSCLC) in 2007 and there has been rapid progress in applying this knowledge to the benefit of patients. However, we have a poor understanding of EML4 and ALK biology and there are many challenges to devising the optimal strategy for treating EML4-ALK NSCLC patients. In this review, we describe the biology of EML4 and ALK, explain the main features of EML4-ALK fusion proteins and outline the therapies that target EML4-ALK. In particular, we highlight the recent advances in our understanding of the structures of EML proteins, describe the molecular mechanisms of resistance to ALK inhibitors and assess current thinking about combinations of ALK drugs with inhibitors that target other kinases or Hsp90.
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Affiliation(s)
- Richard Bayliss
- Department of Molecular and Cell Biology, University of Leicester, Lancaster Road, Leicester, LE2 9HN, UK.
- Astbury Centre for Structural Molecular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK.
| | - Jene Choi
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Seoul, Korea
| | - Dean A Fennell
- Cancer Research UK Centre, University of Leicester, Lancaster Road, Leicester, LE3 9SQ, UK
| | - Andrew M Fry
- Department of Molecular and Cell Biology, University of Leicester, Lancaster Road, Leicester, LE2 9HN, UK
| | - Mark W Richards
- Department of Molecular and Cell Biology, University of Leicester, Lancaster Road, Leicester, LE2 9HN, UK
- Astbury Centre for Structural Molecular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
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Liang W, He Q, Chen Y, Chuai S, Yin W, Wang W, Peng G, Zhou C, He J. Metastatic EML4-ALK fusion detected by circulating DNA genotyping in an EGFR-mutated NSCLC patient and successful management by adding ALK inhibitors: a case report. BMC Cancer 2016; 16:62. [PMID: 26850068 PMCID: PMC4744376 DOI: 10.1186/s12885-016-2088-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/27/2016] [Indexed: 01/17/2023] Open
Abstract
Background Rebiopsy is highly recommended to identify the mechanism of acquired resistance to EGFR-TKIs in advanced lung cancer. Recent advances in multiplex genotyping based on circulating tumor DNA (ctDNA) provide a strong and non-invasive alternative for detection of the resistance mechanism. Case presentation Here we report a multiple metastatic NSCLC patient who was detected to have pure EGFR 19 exon deletion (negative for EML4-ALK and ROS1 in both IHC-based and sequencing assay) in the primary lesion and responded to first-line and second-line EGFR-TKI treatments (erlotinib then HY-15772). At 8 months, most lesions remained well controlled except for the liver metastases which presented dramatic progression. Considering the high risk of bleeding in rebiopsy of hepatic lesions, we conducted a multiplex genomic profiling with ctDNA. Results reported coexistence of EGFR mutation and EML4-ALK gene translocation in plasma which heavily indicated that ALK was the primary reason for progression of the liver lesions. This deduction was supported by the repeated response to ALK inhibitors (crizotinib then AP26113) of the hepatic metastases. Conclusions This is the first report of the existence of ALK rearrangement in metastatic lesions in an EGFR mutated patient. It highlighted the feasibility and advantages of using ctDNA multiplex genotyping in identifying the heterogeneity across lesions and the resistance mechanism of targeted treatments. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2088-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, No. 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, PR China.
| | - Qihua He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, No. 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, PR China.
| | - Ying Chen
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, No. 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, PR China.
| | - Shaokun Chuai
- Burning Rock Biotechnology Co. Ltd., Guangzhou, China.
| | - Weiqiang Yin
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, No. 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, PR China.
| | - Wei Wang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, No. 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, PR China.
| | - Guilin Peng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, No. 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, PR China.
| | - Caicun Zhou
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, No. 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, PR China. .,Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, No. 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, PR China.
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