RTK and BRAF fusions are rare but potentially druggable resistance mechanisms to EGFR TKIs. Detection of RTK and BRAF fusions should be part of comprehensive profiling panels to determine resistance to EGFR TKIs and direct appropriate combination therapeutic strategies.
The COVID-19 pandemic has impacted cancer screening, [1][2][3] with multistate data reporting reductions in breast, colon, and cervical cancer screenings but not reporting on lung cancer screening (LCS). 4 In late April 2020, the Radiological Society of North America COVID-19 Task Force suggested postponing nonurgent outpatient imaging, including LCS. 3 Also in April 2020, an expert panel of 24 physicians provided guidance for LCS during the pandemic, stating it was appropriate to defer enrollment in LCS for new patients and to delay annual screening but that patient preferences should also be considered. 1 Patients eligible for LCS have significant smoking exposure and underlying comorbidities, 5 putting this group at increased risk for infection and severe complications from COVID-19. Although two studies reported reductions in LCS at the start of the pandemic, 6,7 differences in screening volumes based on patient characteristics and COVID-19 risk factors were not reported. We sought to compare LCS volumes from multiple screening centers before and during the pandemic to determine whether patients who underwent LCS differ based on sociodemographic and COVID-19 risk factors. If certain subgroups of the population are less likely to undergo LCS or delay LCS during the ongoing COVID-19 pandemic, this may impact downstream lung cancer disparities.
ALK-rearranged lung cancer defines a distinctive molecular cohort of patients whose outcomes are significantly improved by the availability of ALK inhibitors. Thus, it is imperative for clinicians to screen appropriate patients for this driver mutation with a molecular testing platform capable of capturing all ALK fusions. Here, we report a novel VKORC1L1-ALK fusion and an ALK T1151K resistance mutation detected in a lung cancer patient who had been on crizotinib for over 8 years. Alectinib induced a dramatic response in this patient demonstrating its clinical activity against T1151K. This case illustrates the importance of performing repeat biopsy to explore mechanism(s) of resistance when patients experience disease progression on an ALK inhibitor. The approach has a direct therapeutic impact particularly when an ALK resistance mutation is identified.
There is significant anisotropic variability of infrarenal inferior vena cava geometry with significantly greater expansive and compressive forces in the minor axis. There can be significant volumetric changes in the inferior vena cava with associated perimeter changes but the major axis left-anterior oblique caval configuration is always maintained. These significant dynamic forces may impact inferior vena cava filter stability after implantation. The consistent major axis left-anterior oblique obliquity may lead to underestimation of the inferior vena cava diameter used in standard anteroposterior venography, which may influence initial filter selection.
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