title: A heterochronic genetic change from an EGFR mutation to an ALK rearrangement in a patient with lung adenocarcinoma: a case report.
abstract: An 87-year-old man with postoperative recurrent lung adenocarcinoma was treated with gefitinib. At the beginning of treatment, surgically resected archived tumor tissue revealed a deletion in exon 19 of the EGFR gene, but no ALK gene rearrangement. After gefitinib treatment for 9 months, the disease progressed. Bronchoscopic rebiopsy was used to evaluate resistance mechanisms, and revealed lung adenocarcinoma with wild-type EGFR genes and a newly emerged ALK gene rearrangement. Treatment was switched to alectinib and a partial response was achieved within 4 weeks. This is a rare case of heterochronic genetic change to an ALK gene rearrangement in EGFR mutant lung adenocarcinoma.
authors.affiliation: 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shiroyama
authors.affiliation: 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Tamiya
authors.affiliation: 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Hayama
authors.affiliation: 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishihara
authors.affiliation: 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Nishida
authors.affiliation: 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Tanaka
authors.affiliation: 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Morishita
authors.affiliation: 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Okamoto
authors.affiliation: 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors.forename: Kunimitsu
authors.initials: K
authors.lastname: Kawahara
authors.affiliation: 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hirashima
keywords: ALK gene rearrangement; EGFR mutation; alectinib; resistance mechanism