| Autor: |
Chun Leung, Jackson Ka, Chun Kwok, Wang, Fung Leung, Arthur Chun, Tsui, Po, Man Ho, James Chung |
| Zdroj: |
JTO Clinical and Research Reports; 20230101, Issue: Preprints |
| Abstrakt: |
We report a case of pathologically confirmed anaplastic lymphoma kinase (ALK)-rearranged metastatic lung adenocarcinoma with emergence of epidermal growth factor receptor (EGFR) L858R mutation upon disease progression after two lines of treatment with ALK inhibitors. At initial diagnosis, tumoural ALK expression was detected without EGFR mutation by standard allele-specific polymerase chain reaction. There was sustained partial response to both first-line crizotinib and subsequent brigatinib. Upon disease progression to brigatinib, liquid biopsy with circulating tumour DNA revealed only EGFR L858R, which was confirmed by tumour rebiopsy on supraclavicular lymph node. He was then treated initially with pemetrexed and carboplatin, and erlotinib was subsequently added after 2 cycles of chemotherapy. The combination treatment has resulted in very good partial response and mild adverse effects. The overall clinical course would suggest the initial presence of two separate tumour clones, with ALK dominance at diagnosis. The subsequent breakthrough disease progression after initial response to brigatinib was related to uncontrolled growth of the EGFR mutated tumour subpopulation. The implication on defining molecular mechanism of acquired resistance and treatment strategy would be discussed. |
| Databáze: |
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