Tanaka H et al. (2012), A case of lung adenocarcinoma harboring EGFR mu...

ECB-ART-50109

BMC Cancer 2012 Nov 26;12:558. doi: 10.1186/1471-2407-12-558.

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A case of lung adenocarcinoma harboring EGFR mutation and EML4-ALK fusion gene.

Tanaka H , Hayashi A , Morimoto T , Taima K , Tanaka Y , Shimada M , Kurose A , Takanashi S , Okumura K .

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BACKGROUND: Lung cancer is the leading cause of cancer-related death worldwide. Epidermal growth factor receptor (EGFR)--tyrosine kinase inhibitor (TKI) is used for the patients with EGFR-mutant lung cancer. Recently, phase III studies in the patients with EGFR-mutant demonstrated that EGFR-TKI monotherapy improved progression-free survival compared with platinum-doublet chemotherapy. The echinoderm microtubule-associated protein-like 4 (EML4)--anaplastic lymphoma kinase (ALK) fusion oncogene represents one of the newest molecular targets in non-small cell lung cancer (NSCLC). Patients who harbor EML4-ALK fusions have been associated with a lack of EGFR or KRAS mutations. CASE PRESENTATION: We report a 39-year-old patient diagnosed as adenocarcinoma harboring EGFR mutation and EML4-ALK fusion gene. We treated this patient with erlotinib as the third line therapy, but no clinical benefit was obtained. CONCLUSION: We experienced a rare case with EGFR mutation and EML4-ALK. Any clinical benefit using EGFR-TKI was not obtained in our case. The therapeutic choice for the patients with more than one driver mutations is unclear. We needs further understanding of the lung cancer molecular biology and the biomarker information.

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References [+] :

Camidge, Anaplastic lymphoma kinase gene rearrangements in non-small cell lung cancer are associated with prolonged progression-free survival on pemetrexed. 2011, Pubmed

	Figure 1. A. Chest radiography revealed a mass shadow in the left upper lung field. Figure 1B, 1C. Compared with the initial computed tomography (CT) of thorax (B) and the repeated CT at 30 days after erlotinib treatment (C).
	Figure 2. Histology of the primary tumor: (A) well differentiated adenocarcinoma component with acinar pattern (HE ×200).(B) Immunohistochemical examination revealed that tumor cells were positive for monoclonal anti-ALK antibody (5A4) (×200).
	Figure 3. EGFR-gene mutation (L858R point mutation) was showed positive by Cycleave-PCR method.
	Figure 4. ALK fusion expression was showed positive by RT-PCR validation.