title: First line crizotinib in anaplastic lymphoma kinase (ALK) rearranged squamous cell lung cancer.
abstract: Recently the superiority of Crizotinib to standard first-line pemetrexed-plus-platinum chemotherapy in patients with previously untreated advanced ALK-positive NSCLC has been demonstrated. We report of a 36-year-old never smoker with advanced squamous cell carcinoma, presenting with a left lower lobe lesion, N3 nodal disease and multiple metastases (pleura, adrenal, muscle, bone). Despite squamous histology we decided on molecular testing. IHC for ALK was positive and confirmatory fluorescent in situ hybridization showed translocation of ALK. Although there is little evidence on ALK rearrangements in squamous NSCLC we decided on first line treatment with Crizotinib (250 mg twice daily). Eight and twelve weeks after treatment initiation a whole-body FDG fusion PET/CT scan showed dramatic tumor response with little remaining metabolic uptake in the left lobe and a single bone lesion. This evidence raises the question whether ALK testing should be done in never smokers with squamous NSCLC in the absence of oncogenic driver mutations. To our knowledge, this the first report of first line treatment of full squamous ALK-positive NSCLC with crizotinib.
authors.affiliation: Department of Pulmonary Medicine, University Clinic Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria. Electronic address: r.mikes@salk.at.
authors.forename: Romana E
authors.initials: RE
authors.lastname: Mikes
authors.affiliation: Department of Pulmonary Medicine, University Clinic Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria. Electronic address: f.jordan@salk.at.
authors.forename: Franziska
authors.initials: F
authors.lastname: Jordan
authors.affiliation: Department of Pathology, University Clinic Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria. Electronic address: g.hutarew@salk.at.
authors.forename: Georg
authors.initials: G
authors.lastname: Hutarew
authors.affiliation: Department of Pulmonary Medicine, University Clinic Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria. Electronic address: m.studnicka@salk.at.
authors.forename: Michael
authors.initials: M
authors.lastname: Studnicka
mesh_terms: D000077548:Anaplastic Lymphoma Kinase; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015415:Biomarkers; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics*; D000077547:Crizotinib; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics*; D008207:Lymphatic Metastasis; D008297:Male; D049268:Positron-Emission Tomography; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011720:Pyrazoles / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use*; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics*; D014057:Tomography, X-Ray Computed; D014178:Translocation, Genetic; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D047428:Protein Kinase Inhibitors; D011720:Pyrazoles; D011725:Pyridines; D000077547:Crizotinib; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D020794:Receptor Protein-Tyrosine Kinases
keywords: ALK rearrangement; Crizotinib; Squamous cell lung cancer