A heterochronic genetic change from an EGFR mutation to an ALK rearrangement in a patient with lung adenocarcinoma: a case report

• DOI: 10.21037/jtd.2016.03.43
• Publication Date: 2016-04-21T06:27:06Z
• Authors: Takayuki Shiroyama; Motohiro Tamiya; Manabu Hayama; Takashi Nishihara; Takuji Nishida; Ayako Tanaka; Naoko Morishita; Hidekazu Suzuki; Norio Okamoto; Kunimitsu Kawahara; Tomonori Hirashima
• Keywords: Alectinib; Gene rearrangement

An 87-year-old man with postoperative recurrent lung adenocarcinoma was treated gefitinib. At the beginning of treatment, surgically resected archived tumor tissue revealed a deletion in exon 19 EGFR gene, but no ALK gene rearrangement. After gefitinib treatment for 9 months, disease progressed. Bronchoscopic rebiopsy used to evaluate resistance mechanisms, and wild-type genes newly emerged Treatment switched alectinib partial response achieved within 4 weeks. This is rare case heterochronic genetic change an rearrangement mutant adenocarcinoma.