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Case report: anaplastic lymphoma kinase (ALK) rearranged adenocarcinoma with high level of microsatellite instability response to pembrolizumab

The presence of anaplastic lymphoma kinase (ALK) rearrangement is reported to be related to the lack of efficacy of immune checkpoint inhibitors (ICIs). High levels of microsatellite instability (MSI-high) are important biomarkers of ICIs, particularly in colorectal cancer. The therapeutic effect of...

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Autores principales: Shigeta, Naoko, Murakami, Shuji, Yokose, Tomoyuki, Miyagi, Yohei, Saito, Haruhiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10126330/
https://www.ncbi.nlm.nih.gov/pubmed/37114121
http://dx.doi.org/10.3389/fonc.2023.1110638
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author Shigeta, Naoko
Murakami, Shuji
Yokose, Tomoyuki
Miyagi, Yohei
Saito, Haruhiro
author_facet Shigeta, Naoko
Murakami, Shuji
Yokose, Tomoyuki
Miyagi, Yohei
Saito, Haruhiro
author_sort Shigeta, Naoko
collection PubMed
description The presence of anaplastic lymphoma kinase (ALK) rearrangement is reported to be related to the lack of efficacy of immune checkpoint inhibitors (ICIs). High levels of microsatellite instability (MSI-high) are important biomarkers of ICIs, particularly in colorectal cancer. The therapeutic effect of ICIs for MSI-high NSCLC is uncertain because of the rarity of these tumors. Here we report a case of ALK rearranged NSCLC with MSI-high. A 48-year-old male was diagnosed with lung adenocarcinoma, cT4N3M1a, stage IVA with ALK rearrangement, high PD-L1 expression with a tumor proportion score (TPS) of 100%, and MSI-high. The patient was treated with alectinib as the first-line therapy but progressed at five months with left atrial invasion re-expansion. The patient discontinued alectinib and was switched to pembrolizumab monotherapy. After two months, left atrial invasion significantly decreased. The patient continued pembrolizumab for a year without noticeable adverse events, and tumor shrinkage persisted. This case supports the efficacy of ICIs for MSI-high NSCLC, even in the presence of ALK rearrangement.
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spelling pubmed-101263302023-04-26 Case report: anaplastic lymphoma kinase (ALK) rearranged adenocarcinoma with high level of microsatellite instability response to pembrolizumab Shigeta, Naoko Murakami, Shuji Yokose, Tomoyuki Miyagi, Yohei Saito, Haruhiro Front Oncol Oncology The presence of anaplastic lymphoma kinase (ALK) rearrangement is reported to be related to the lack of efficacy of immune checkpoint inhibitors (ICIs). High levels of microsatellite instability (MSI-high) are important biomarkers of ICIs, particularly in colorectal cancer. The therapeutic effect of ICIs for MSI-high NSCLC is uncertain because of the rarity of these tumors. Here we report a case of ALK rearranged NSCLC with MSI-high. A 48-year-old male was diagnosed with lung adenocarcinoma, cT4N3M1a, stage IVA with ALK rearrangement, high PD-L1 expression with a tumor proportion score (TPS) of 100%, and MSI-high. The patient was treated with alectinib as the first-line therapy but progressed at five months with left atrial invasion re-expansion. The patient discontinued alectinib and was switched to pembrolizumab monotherapy. After two months, left atrial invasion significantly decreased. The patient continued pembrolizumab for a year without noticeable adverse events, and tumor shrinkage persisted. This case supports the efficacy of ICIs for MSI-high NSCLC, even in the presence of ALK rearrangement. Frontiers Media S.A. 2023-04-11 /pmc/articles/PMC10126330/ /pubmed/37114121 http://dx.doi.org/10.3389/fonc.2023.1110638 Text en Copyright © 2023 Shigeta, Murakami, Yokose, Miyagi and Saito https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Shigeta, Naoko
Murakami, Shuji
Yokose, Tomoyuki
Miyagi, Yohei
Saito, Haruhiro
Case report: anaplastic lymphoma kinase (ALK) rearranged adenocarcinoma with high level of microsatellite instability response to pembrolizumab
title Case report: anaplastic lymphoma kinase (ALK) rearranged adenocarcinoma with high level of microsatellite instability response to pembrolizumab
title_full Case report: anaplastic lymphoma kinase (ALK) rearranged adenocarcinoma with high level of microsatellite instability response to pembrolizumab
title_fullStr Case report: anaplastic lymphoma kinase (ALK) rearranged adenocarcinoma with high level of microsatellite instability response to pembrolizumab
title_full_unstemmed Case report: anaplastic lymphoma kinase (ALK) rearranged adenocarcinoma with high level of microsatellite instability response to pembrolizumab
title_short Case report: anaplastic lymphoma kinase (ALK) rearranged adenocarcinoma with high level of microsatellite instability response to pembrolizumab
title_sort case report: anaplastic lymphoma kinase (alk) rearranged adenocarcinoma with high level of microsatellite instability response to pembrolizumab
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10126330/
https://www.ncbi.nlm.nih.gov/pubmed/37114121
http://dx.doi.org/10.3389/fonc.2023.1110638
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