Remarkable response to alectinib for metastatic papillary thyroid cancer with STRN-ALK fusion: A case report

Abstract

Little is known about the efficacy of alectinib for papillary thyroid cancer with STRN-ALK fusion. A 64-year-old female presented with metastatic papillary thyroid cancer, widespread to lungs, mediastinal lymph nodes and brain 20 years after surgery. Disease progression still occurred after radioactive iodine therapy, chemotherapy, and radiotherapy. Tissue obtained from left cervical lymph node confirmed metastatic papillary thyroid cancer. Molecular profiling from re-biopsy tissue identified an STRN-ALK fusion rearrangement. After multidisciplinary discussion, alectinib was administered to the patient. Treatment was well tolerated, and follow-up images confirmed a partial response. ALK occurs rarely, with limited data suggesting the efficacy of ALK inhibitors in thyroid cancer. We presented the first case of a patient with PTC and STRN-ALK fusion to be treat effectively with alectinib.

Emerging therapeutic options for follicular-derived thyroid cancer in the era of immunotherapy

“…In NTRK fusion-positive DTC, the selective TRK inhibitors larotrectinib and entrectinib have also shown prolonged OS and PFS, with a 24-month PFS of 84% with larotrectinib and a median PFS of 19.9 months with entrectinib ( 22 , 23 ). Moreover, selective ALK inhibitors have been successfully used in case reports of ALK fusion-positive DTCs ( 138 , 139 ). Due to minimal off-target activity, these selective kinase inhibitors have more acceptable toxicity profiles compared to antiangiogenic kinase inhibitors, justifying their choice as first-line therapies when possible.…”

An Era of Advances in Systemic Therapies for Advanced Thyroid Cancer

“…28,29 ALK fusions occur in 1%-3% of PTCs, and case reports have shown clinical responses in patients with ALK fusion-positive DTCs treated with alectinib, crizotinib, and lorlatinib. 28,[30][31][32][33] In addition, even more rare than ALK fusions are ROS1 gene rearrangements in DTCs. ROS1 fusions have been described in two case reports of PTCs, in which CCDC30-ROS1 and EZR-ROS1 fusions were detected.…”