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Refinement of diagnosis and supporting evidence for the use of immunotherapy through sequential biopsies in a case of EML4-ALK positive lung cancer

Authors Song P, Zhang J, Zhang L

Received 28 January 2019

Accepted for publication 12 March 2019

Published 17 April 2019 Volume 2019:12 Pages 2943—2948

DOI https://doi.org/10.2147/OTT.S203192

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Tohru Yamada


Video abstract presented by Peng Song.

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Peng Song,1 Jingcheng Zhang,2 Li Zhang1

1Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Internal Medicine, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People’s Republic of China

Abstract: In this case report, we describe a tortuous, yet rare, treatment process of the patient. The first biopsy of the patient suggested inflammatory myofibroblastic tumor, ALK (D5F3) positive. Considering the benign progression of the disease, and no indication for surgical resection, oral prednisone was given first. However, the disease rapidly progressed, and a second biopsy revealed a pulmonary sarcomatoid cancer. Since the biopsy was ALK (D5F3) positive, the effect of crizotinib treatment was significant, though crizotinib resistance unfortunately only occurred after 4 months. The third biopsy pathology was performed and confirmed lung adenocarcinoma. After switching to pembrolizumab treatment, the lesions were significantly reduced after four courses of treatment. The current condition of patient persisted in partial response.

Keywords: sequential biopsies, EML4-ALK, immunotherapy, lung adenocarcinoma


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