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CASE REPORT article

Front. Oncol.
Sec. Pharmacology of Anti-Cancer Drugs
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1453259

Coexistence of a novel SV2B-ALK, EML4-ALK double-fusion in a lung poorly differentiated adenocarcinoma patient and response to alectinib: A case report and literature review

Provisionally accepted
Yujuan Qi Yujuan Qi 1*Dingrong Zhong Dingrong Zhong 2*Chen Huang Chen Huang 2*Menglan Zhang Menglan Zhang 1Liyan Bai Liyan Bai 1Yun Niu Yun Niu 2*Xiaowei Wang Xiaowei Wang 2*Ruiying Jiang Ruiying Jiang 2*Ye Wang Ye Wang 2*Qianqian Feng Qianqian Feng 2*Bei Wang Bei Wang 2*Tingli Dai Tingli Dai 2*Mingming Yuan Mingming Yuan 3Rongrong Chen Rongrong Chen 3
  • 1 Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
  • 2 China-Japan Friendship Hospital, Beijing, China
  • 3 Geneplus Beijing Institute, Huilongguan Town, Beijing, China

The final, formatted version of the article will be published soon.

    Background: Anaplastic lymphoma kinase (ALK) rearrangement, the most common oncogenic rearrangement in lung adenocarcinoma, occurs in approximately 5% of non-small cell lung cancer (NSCLC) patients. EML4 gene is the most common partner of ALK rearrangement, and distinct EML4-ALK fusions differ in their responsiveness to ALK tyrosine kinase inhibitors. However, the concurrence of two ALK rearrangements in one patient and whose response to ALK-TKIs have rarely been reported so far.Case Presentation: A 47-year-old Chinese male was diagnosed with stage IV lung adenocarcinoma with multiple intracranial metastases and adrenal metastasis. After progression of two lines of chemotherapy combined with local radiotherapy regimens, his tumor tissue sample was sent to perform the DNA-based next-generation sequencing of 116 genes. Surprisingly, EML4-ALK (E13:A20) fusion and a novel SV2B-ALK (S6:A20) fusion were concurrently identified, which was confirmed using immunohistochemistry and fluorescence in-situ hybridization. Given the superior efficacy of alectinib, the patient received alectinib in the third-line setting with the progression-free survival over 14 months up to now. Moreover, through comprehensive review of previous literatures, a total of 22 patients with multiple ALK fusions and their response to ALK-TKIs were summarized.This is the first report of a NSCLC patient with a novel SV2B-ALK, EML4-ALK double-fusion benefiting from alectinib. Alectinib may be an effective therapeutic option for both primary and metastatic lesions including brain metastases in the late -line setting in NSCLC patients with double-ALK fusion.

    Keywords: Alectinib, ALK Double Fusions, CNS metastases, NSCLC, SV2B-ALK Novel Fusion

    Received: 22 Jun 2024; Accepted: 26 Nov 2024.

    Copyright: © 2024 Qi, Zhong, Huang, Zhang, Bai, Niu, Wang, Jiang, Wang, Feng, Wang, Dai, Yuan and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Yujuan Qi, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
    Dingrong Zhong, China-Japan Friendship Hospital, Beijing, China
    Chen Huang, China-Japan Friendship Hospital, Beijing, China
    Yun Niu, China-Japan Friendship Hospital, Beijing, China
    Xiaowei Wang, China-Japan Friendship Hospital, Beijing, China
    Ruiying Jiang, China-Japan Friendship Hospital, Beijing, China
    Ye Wang, China-Japan Friendship Hospital, Beijing, China
    Qianqian Feng, China-Japan Friendship Hospital, Beijing, China
    Bei Wang, China-Japan Friendship Hospital, Beijing, China
    Tingli Dai, China-Japan Friendship Hospital, Beijing, China

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