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Patients harboring ALK rearrangement adenocarcinoma after acquired resistance to crizotinib and transformation to small-cell lung cancer: a case report

Authors Zhu Y, Liao X, Wang W, Xu C, Zhuang W, Zhong L, Du K, Chen Y, Chen G, Fang M

Received 15 April 2017

Accepted for publication 6 June 2017

Published 27 June 2017 Volume 2017:10 Pages 3187—3192

DOI https://doi.org/10.2147/OTT.S139718

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Ingrid Espinoza

You-cai Zhu,1 Xing-hui Liao,2 Wen-xian Wang,3 Chun-wei Xu,4 Wu Zhuang,5 Li-hua Zhong,4 Kai-qi Du,1 Yan-ping Chen,4 Gang Chen,4 Mei-yu Fang6

1Department of Chest Disease Diagnosis and Treatment Center, 2Department of Tumor Molecular Laboratory, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, 3Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 4Department of Pathology, Fujian Provincial Cancer Hospital, 5Department of Medical Thoracic Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian, Fuzhou, 6Department of Comprehensive Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People’s Republic of China

Abstract: Anaplastic lymphoma kinase (ALK) rearrangement responds to ALK tyrosine kinase inhibitors (TKIs) in lung cancer. Many cases ultimately acquire resistance to crizotinib. Resistance, including ALK-dominant or ALK non-dominant, mechanisms have been described. Transformation to small-cell lung cancer is rare. Herein, we report a 49-year-old man diagnosed with adenocarcinoma, who was negative for EGFR and ALK genes as detected by reverse transcription polymerase chain reaction, and was treated with crizotinib. A new biopsy showed a small-cell lung cancer after disease progression. Then, next-generation sequencing (NGS) was carried out and detected a TP53 gene mutation, an ALK rearrangement, and no loss of the retinoblastoma gene (RB). Although a regimen for small-cell lung cancer may be one treatment option, a heterogeneous tumor may exist at the time of diagnosis and manifest during the course of disease.

Keywords: lung cancer, ALK, crizotinib, small-cell lung cancer

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Published Date: 15 July 2016