ALK-rearranged and EGFR wild-type lung adenocarcinoma transformed to small cell lung cancer: a case report
BackgroundCases of ALK-rearranged EGFR wild-type lung adenocarcinoma (LUAD) transforming into small cell lung cancer (SCLC) are rarely reported, and diagnosis is often delayed. The emergence of this transformation phenomenon is often regarded as a consequence of acquired resistance mechanisms.Case p...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-04-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1395654/full |
| _version_ | 1797196802326265856 |
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| author | Rui Chen Yan Jian Yuzhen Liu Junping Xie |
| author_facet | Rui Chen Yan Jian Yuzhen Liu Junping Xie |
| author_sort | Rui Chen |
| collection | DOAJ |
| description | BackgroundCases of ALK-rearranged EGFR wild-type lung adenocarcinoma (LUAD) transforming into small cell lung cancer (SCLC) are rarely reported, and diagnosis is often delayed. The emergence of this transformation phenomenon is often regarded as a consequence of acquired resistance mechanisms.Case presentationA 47-year-old male diagnosed with poorly differentiated adenocarcinoma of the right middle lung (pT2N2M0, stage IIIA) achieved a 46-month progression-free survival (PFS) following surgery and adjuvant chemotherapy. During routine follow-up, tumor recurrence and metastasis was detected. Genetic testing revealed ALK rearrangement and wild-type EGFR, prompting treatment with ALK-TKIs. In May 2023, abdominal CT scans showed significant progression of liver metastases and abnormal elevation of the tumor marker NSE. Immunohistochemical results from percutaneous liver biopsy indicated metastatic SCLC.ResultsAfter resistance to ALK-TKIs and transformation to SCLC, the patient received chemotherapy combined with immunotherapy for SCLC, but the patient’s disease progressed rapidly. Currently, the patient is being treated with albumin-bound paclitaxel in combination with oral erlotinib and remains stable.ConclusionHistological transformation emerges as a compelling mechanism of resistance to ALK-TKIs, necessitating the utmost urgency for repeat biopsies in patients displaying disease progression after resistance. These biopsies are pivotal in enabling the tailor-made adaptation of treatment regimens to effectively counteract the assorted mechanisms of acquired resistance, thus optimizing patient outcomes in the battle against ALK-driven malignancies. |
| first_indexed | 2024-04-24T06:33:51Z |
| format | Article |
| id | doaj.art-dbe39b5c344b48bfa00f8b45312801c8 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-24T06:33:51Z |
| publishDate | 2024-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-dbe39b5c344b48bfa00f8b45312801c82024-04-23T04:33:43ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2024-04-011410.3389/fonc.2024.13956541395654ALK-rearranged and EGFR wild-type lung adenocarcinoma transformed to small cell lung cancer: a case reportRui Chen0Yan Jian1Yuzhen Liu2Junping Xie3Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaJiangxi Provincial Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, ChinaGraduate School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaDepartment of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaBackgroundCases of ALK-rearranged EGFR wild-type lung adenocarcinoma (LUAD) transforming into small cell lung cancer (SCLC) are rarely reported, and diagnosis is often delayed. The emergence of this transformation phenomenon is often regarded as a consequence of acquired resistance mechanisms.Case presentationA 47-year-old male diagnosed with poorly differentiated adenocarcinoma of the right middle lung (pT2N2M0, stage IIIA) achieved a 46-month progression-free survival (PFS) following surgery and adjuvant chemotherapy. During routine follow-up, tumor recurrence and metastasis was detected. Genetic testing revealed ALK rearrangement and wild-type EGFR, prompting treatment with ALK-TKIs. In May 2023, abdominal CT scans showed significant progression of liver metastases and abnormal elevation of the tumor marker NSE. Immunohistochemical results from percutaneous liver biopsy indicated metastatic SCLC.ResultsAfter resistance to ALK-TKIs and transformation to SCLC, the patient received chemotherapy combined with immunotherapy for SCLC, but the patient’s disease progressed rapidly. Currently, the patient is being treated with albumin-bound paclitaxel in combination with oral erlotinib and remains stable.ConclusionHistological transformation emerges as a compelling mechanism of resistance to ALK-TKIs, necessitating the utmost urgency for repeat biopsies in patients displaying disease progression after resistance. These biopsies are pivotal in enabling the tailor-made adaptation of treatment regimens to effectively counteract the assorted mechanisms of acquired resistance, thus optimizing patient outcomes in the battle against ALK-driven malignancies.https://www.frontiersin.org/articles/10.3389/fonc.2024.1395654/fullnon-small cell lung cancersmall cell lung cancertransformationALK-TKIsliver metastasis |
| spellingShingle | Rui Chen Yan Jian Yuzhen Liu Junping Xie ALK-rearranged and EGFR wild-type lung adenocarcinoma transformed to small cell lung cancer: a case report Frontiers in Oncology non-small cell lung cancer small cell lung cancer transformation ALK-TKIs liver metastasis |
| title | ALK-rearranged and EGFR wild-type lung adenocarcinoma transformed to small cell lung cancer: a case report |
| title_full | ALK-rearranged and EGFR wild-type lung adenocarcinoma transformed to small cell lung cancer: a case report |
| title_fullStr | ALK-rearranged and EGFR wild-type lung adenocarcinoma transformed to small cell lung cancer: a case report |
| title_full_unstemmed | ALK-rearranged and EGFR wild-type lung adenocarcinoma transformed to small cell lung cancer: a case report |
| title_short | ALK-rearranged and EGFR wild-type lung adenocarcinoma transformed to small cell lung cancer: a case report |
| title_sort | alk rearranged and egfr wild type lung adenocarcinoma transformed to small cell lung cancer a case report |
| topic | non-small cell lung cancer small cell lung cancer transformation ALK-TKIs liver metastasis |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1395654/full |
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