title: Response to erlotinib in a patient with lung adenocarcinoma harbouring theEML4-ALKtranslocation: A case report.
abstract: Lung cancer is the leading cause of cancer-associated mortality worldwide, and the mainstay of treatment remains to be personalised therapy. Tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR-TKIs) have been reported to exert a significant impact in the treatment of non-small cell lung cancer (NSCLC), particularly in patients harbouring mutations in theEGFRgene. The echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) gene translocation has been described in a subset of patients with NSCLC and possesses potent oncogenic activity. This translocation represents one of the most novel molecular targets in the treatment of NSCLC. Patients who harbour theEML4-ALKrearrangement possess lung tumours that lackEGFRorK-rasmutations. The present study reports the case of a patient possessing theEML4-ALKrearrangement that was initially treated with erlotinib and achieved a lasting clinical response. To the best of our knowledge, the current study is the first report of a clinical response to EGFR-TKI in a patient with lung adenocarcinoma harbouring theEML4-ALKfusion gene, but noEGFRmutations. However, as the disease progressed, theALKgene status of the tumour was investigated, and based upon a positive result, the patient was treated with crizotinib and achieved a complete response. In conclusion, the present study suggests that theEML4-ALKrearrangement is not always associated with resistance to EGFR-TKIs. Further studies are required to clarify the biological features of these tumours and to investigate the mechanisms underlying the primary resistance to EGFR-TKIs when theEML4-ALKrearrangement is present.
authors: Department of Pathological Anatomy, Azienda Ospedaliera Universitaria Pisana, Pisa, Tuscany I-56126, Italy.
authors: Greta
authors: G
authors: Alì
authors: Department of Pneumology, Azienda Ospedaliera Universitaria Pisana, Pisa, Tuscany I-56126, Italy.
authors: Antonio
authors: A
authors: Chella
authors: Department of Pathological Anatomy, Azienda Ospedaliera Universitaria Pisana, Pisa, Tuscany I-56126, Italy.
authors: Cristiana
authors: C
authors: Lupi
authors: Department of Surgical, Medical, Molecular Pathology and Critical Care, Division of Pathological Anatomy, University of Pisa, Pisa, Tuscany I-56126, Italy.
authors: Agnese
authors: A
authors: Proietti
authors: Department of Surgical, Medical, Molecular Pathology and Critical Care, Division of Pathological Anatomy, University of Pisa, Pisa, Tuscany I-56126, Italy.
authors: Cristina
authors: C
authors: Niccoli
authors: Department of Surgical, Medical, Molecular Pathology and Critical Care, Division of Pathological Anatomy, University of Pisa, Pisa, Tuscany I-56126, Italy.
authors: Laura
authors: L
authors: Boldrini
authors: Unit of Thoracic Surgery, Azienda Ospedaliera Universitaria Pisana, Pisa, Tuscany I-56126, Italy.
authors: Federico
authors: F
authors: Davini
authors: Department of Surgical, Medical, Molecular Pathology and Critical Care, Division of Thoracic Surgery, University of Pisa, Pisa, Tuscany I-56126, Italy.
authors: Alfredo
authors: A
authors: Mussi
authors: Department of Surgical, Medical, Molecular Pathology and Critical Care, Division of Pathological Anatomy, University of Pisa, Pisa, Tuscany I-56126, Italy.
authors: Gabriella
authors: G
authors: Fontanini
keywords: EML4-ALK rearrangement; crizotinib; erlotinib; lung adenocarcinoma