EML4-ALK-positive non-small cell lung cancer  in a patient treated with azathioprine  for ulcerative colitis.
EML4-ALK-positive lung cancer is a novel cancer entity associated with light or never smoking, younger age, and adenocarcinoma with acinar or signet-ring cell type histology. Another mutation of ALK with NPM, resulting in NPM-ALK fusion mutation, was described in patients with anaplastic large cell lymphoma (ALCL). It was subsequently reported in organ transplant recipients and patiens undergoing immunosuppressive therapy. We describe a case of lung cancer in a 36-year-old nonsmoking woman with ulcerative colitis treated with azathioprine, who was diagnosed with EML4-ALK-positive, metastatic lung cancer two months postpartum. Crizotinib 300 mg/day has been effective in maintaining response after chemotherapy failed. The resemblance of this case to ALK-positive ALCL in organ transplant recipients suggests that similar mechanisms may be responsible for the development of both ALK-positive lung cancer and ALCL in patients receiving immunosuppressive therapy.
Department of Oncology, Soroka Medical Center and Faculty of Health Sciences,Ben-Gurion University of the Negev, Beer Sheva, Israel.
Irena
I
Lazarev
Netta
N
Sion-Vardy
Samuel
S
Ariad
D000230:Adenocarcinoma / Q000737:chemistry* / Q000188:drug therapy / Q000473:pathology; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001379:Azathioprine / Q000008:administration & dosage*; D014408:Biomarkers, Tumor / Q000032:analysis*; D002289:Carcinoma, Non-Small-Cell Lung / Q000737:chemistry; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D000077547:Crizotinib; D004334:Drug Administration Schedule; D005260:Female; D005971:Glutamates / Q000008:administration & dosage; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008175:Lung Neoplasms / Q000737:chemistry* / Q000188:drug therapy / Q000473:pathology; D015514:Oncogene Proteins, Fusion / Q000032:analysis*; D000068437:Pemetrexed; D011720:Pyrazoles / Q000008:administration & dosage; D011725:Pyridines / Q000008:administration & dosage; D019233:Retreatment; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D014408:Biomarkers, Tumor; C522504:EML4-ALK fusion protein, human; D005971:Glutamates; D007166:Immunosuppressive Agents; D015514:Oncogene Proteins, Fusion; D011720:Pyrazoles; D011725:Pyridines; D000068437:Pemetrexed; D000077547:Crizotinib; D006147:Guanine; D001379:Azathioprine