Concomitant EGFR mutation and ALK rearrangement in multifocal lung adenocarcinoma: a case report

Abstract

Background: The prevalence of EGFR/ALK co-alterations in patients with NSCLC was low. The several previous studies focused on the simultaneous occurrence of EGFR mutations and ALK rearrangements in a unifocal lung cancer. However, the incidence of multifocal pulmonary adenocarcinomas was increasingly encountered in clinical practice, due to the increased availability and improvement of the thoracic imaging. The clinical relevance of EGFR/ ALK co-alterations in multifocal adenocarcinomas required detailed investigation as well. Case presentation: We present the case of a 57-year-old woman with solid nodule in the left upper lung and a ground glass nodule in the left lower lobe, who underwent radical operation. Pathological examination confirmed multifocal adenocarcinoma, molecular tests revealed that the left upper lung lesion was positive for ALK rearrangement but the left lower lobe displayed EGFR mutation positive separately. The patient pulmonary lesions were well controlled by adjuvant chemotherapy and radiation therapy. When brain metastases occurred, EGFR-TKI was not effective after firstly administration, while subsequent ALK inhibitors were efficient. We retrospective evaluated the oncogenic status of metastatic lymph nodes and found that the driver gene was ALK rearrangement rather than EGFR mutation. Conclusions: The status of the oncogenic mutations in lymph node metastasis may provide some effective hints for metastasis lesion in other organ or tissue. Therefore, it is recommended to fully evaluate the driver genes in lymph node metastasis after radical resection.

Repeated treatment with gefitinib and alectinib in a patient with multiple EGFR-mutant and ALK-mutant lung adenocarcinomas: A case report

“…However, these were surgical cases and few treatment cases have been reported. To date, two treatment cases similar to the current case have been reported [ 3 , 4 ]. Tsunezuka et al reported a case in which EGFR-mutant and ALK-mutant double cancer was diagnosed by surgical resection [ 3 ].…”

37. Đặc Điểm Lâm Sàng, Cận Lâm Sàng Và Kết Quả Điều Trị Nhắm Trúng Đích Bệnh Nhân Ung Thư Phổi Không Tế Bào Nhỏ Có Đột Biến Kép Gen Egfr Giai Đoạn 2019-2023

“…Trong nhóm bệnh nhân đồng đột biến (n=43) tỷ lệ xuất hiện đồng đột biến trong nghiên cứu của chúng tôi thường gặp nhất là ALK, PIK3CA. Những loại đột biến này được công bố tỷ lệ xuất hiện đồng thời với đột biến EGFR từ 2-4% tuỳ thuộc từng nghiên cứu [6]- [8]. Ngoài ra còn những đột biến khác cũng có thể gặp trong thực hành lâm sàng như KRAS, BRAF, ROS1, MET.…”

Non-Small Cell Lung Cancer Harboring Concurrent EGFR Genomic Alterations: A Systematic Review and Critical Appraisal of the Double Dilemma

“…Of note, in order to explain the great heterogeneity of clinical outcomes, the authors suggested that different sensitivities to therapies might be correlated with different levels of EGFR or ALK protein phosphorylation. Fan et al described a single case of a patient harboring EGFR/ALK alteration, who had partial response under ALK-TKI [19]. Besides, Lee et al described 12 patients with double EGFR/ALK alteration, 11 of which with a partial response to treatments based on gefitinib, erlotinib or crizotinib [21].…”