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Co-alteration of EGFR mutation and ALK rearrangement in non-small cell lung cancer: Case series
RATIONALE: Current guidelines for advanced non-small cell lung cancer (NSCLC) recommend the use of targeted agents for specific driver genes after confirming genetic alterations. Although epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement are usually...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831261/ https://www.ncbi.nlm.nih.gov/pubmed/30817606 http://dx.doi.org/10.1097/MD.0000000000014699 |
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author | Shin, Hong-Joon Kho, Bo Gun Kim, Min-Seok Park, Ha Young Kim, Tae-Ok Kim, Yu-Il Lim, Sung-Chul Park, Cheol-Kyu Kim, Young-Chul Choi, Yoo-Duk Oh, In-Jae |
author_facet | Shin, Hong-Joon Kho, Bo Gun Kim, Min-Seok Park, Ha Young Kim, Tae-Ok Kim, Yu-Il Lim, Sung-Chul Park, Cheol-Kyu Kim, Young-Chul Choi, Yoo-Duk Oh, In-Jae |
author_sort | Shin, Hong-Joon |
collection | PubMed |
description | RATIONALE: Current guidelines for advanced non-small cell lung cancer (NSCLC) recommend the use of targeted agents for specific driver genes after confirming genetic alterations. Although epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement are usually mutually exclusive, EGFR and ALK co-alterations have been reported increasingly in cases of NSCLC. However, the optimal treatment for these cases has not been established. PATIENT CONCERNS: This case series describes three patients diagnosed with advanced non-squamous NSCLC who harbored EGFR and ALK co-alterations. The complaints for each case are as follows: 57-year-old woman with coughing and dyspnea in case 1, 32-year-old man with diplopia in case 2 and 77-year-old woman with chest discomfort in case 3. DIAGNOSES: Three never-smokers were diagnosed pathologically with stage IV adenocarcinoma of the lung. Subsequent molecular studies revealed the EGFR L858R mutation gene and ALK rearrangement, which were proven by real-time polymerase chain reaction and fluorescence in situ hybridization, respectively. INTERVENTIONS: All 3 patients received first-line therapy with EGFR-tyrosine kinase inhibitors (TKIs). Cases 1 and 2 were treated with ALK-TKIs as second-line therapy and received additional EGFR-TKIs as third- and fourth-line regimens. OUTCOMES: The patients achieved partial responses to EGFR-TKIs according to radiologic findings. However, second-line ALK-TKI therapy was ineffective in cases 1 and 2. LESSONS: Cases of NSCLC with concomitant EGFR mutation and ALK rearrangement are rare, and the selection of an optimal targeted therapy is challenging. Here, EGFR-TKI appeared to yield better outcomes than ALK-TKI in patients with NSCLC who harbored EGFR/ALK co-alterations. |
format | Online Article Text |
id | pubmed-6831261 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-68312612019-11-19 Co-alteration of EGFR mutation and ALK rearrangement in non-small cell lung cancer: Case series Shin, Hong-Joon Kho, Bo Gun Kim, Min-Seok Park, Ha Young Kim, Tae-Ok Kim, Yu-Il Lim, Sung-Chul Park, Cheol-Kyu Kim, Young-Chul Choi, Yoo-Duk Oh, In-Jae Medicine (Baltimore) 5700 RATIONALE: Current guidelines for advanced non-small cell lung cancer (NSCLC) recommend the use of targeted agents for specific driver genes after confirming genetic alterations. Although epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement are usually mutually exclusive, EGFR and ALK co-alterations have been reported increasingly in cases of NSCLC. However, the optimal treatment for these cases has not been established. PATIENT CONCERNS: This case series describes three patients diagnosed with advanced non-squamous NSCLC who harbored EGFR and ALK co-alterations. The complaints for each case are as follows: 57-year-old woman with coughing and dyspnea in case 1, 32-year-old man with diplopia in case 2 and 77-year-old woman with chest discomfort in case 3. DIAGNOSES: Three never-smokers were diagnosed pathologically with stage IV adenocarcinoma of the lung. Subsequent molecular studies revealed the EGFR L858R mutation gene and ALK rearrangement, which were proven by real-time polymerase chain reaction and fluorescence in situ hybridization, respectively. INTERVENTIONS: All 3 patients received first-line therapy with EGFR-tyrosine kinase inhibitors (TKIs). Cases 1 and 2 were treated with ALK-TKIs as second-line therapy and received additional EGFR-TKIs as third- and fourth-line regimens. OUTCOMES: The patients achieved partial responses to EGFR-TKIs according to radiologic findings. However, second-line ALK-TKI therapy was ineffective in cases 1 and 2. LESSONS: Cases of NSCLC with concomitant EGFR mutation and ALK rearrangement are rare, and the selection of an optimal targeted therapy is challenging. Here, EGFR-TKI appeared to yield better outcomes than ALK-TKI in patients with NSCLC who harbored EGFR/ALK co-alterations. Wolters Kluwer Health 2019-03-01 /pmc/articles/PMC6831261/ /pubmed/30817606 http://dx.doi.org/10.1097/MD.0000000000014699 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | 5700 Shin, Hong-Joon Kho, Bo Gun Kim, Min-Seok Park, Ha Young Kim, Tae-Ok Kim, Yu-Il Lim, Sung-Chul Park, Cheol-Kyu Kim, Young-Chul Choi, Yoo-Duk Oh, In-Jae Co-alteration of EGFR mutation and ALK rearrangement in non-small cell lung cancer: Case series |
title | Co-alteration of EGFR mutation and ALK rearrangement in non-small cell lung cancer: Case series |
title_full | Co-alteration of EGFR mutation and ALK rearrangement in non-small cell lung cancer: Case series |
title_fullStr | Co-alteration of EGFR mutation and ALK rearrangement in non-small cell lung cancer: Case series |
title_full_unstemmed | Co-alteration of EGFR mutation and ALK rearrangement in non-small cell lung cancer: Case series |
title_short | Co-alteration of EGFR mutation and ALK rearrangement in non-small cell lung cancer: Case series |
title_sort | co-alteration of egfr mutation and alk rearrangement in non-small cell lung cancer: case series |
topic | 5700 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831261/ https://www.ncbi.nlm.nih.gov/pubmed/30817606 http://dx.doi.org/10.1097/MD.0000000000014699 |
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