ALK-Positive Squamous Cell Carcinoma Dramatically Responded to Alectinib

Abstract

Anaplastic lymphoma kinase (ALK) rearrangement is usually observed in patients with adenocarcinoma. Herein, we report a case of squamous cell carcinoma (SCC) with ALK rearrangement treated with alectinib. The patient was a 73-year-old woman without a smoking history. She consulted us with nonproductive cough and loss of appetite. Computed tomography scan revealed a mass in the left lower lobe of the lung. According to the pathological examinations, we diagnosed the tumor as SCC. Because the patient had never smoked, we searched for driver mutations and found that the tumor harbored ALK rearrangement. We began treatment with alectinib, and the tumor remarkably reduced in volume. No severe adverse events were observed. Although there are only few reports of SCC with ALK rearrangement, this case implies that clinicians should consider searching for driver mutations in patients with SCC when there are atypical findings or characteristics.

Case Report: A Case Report of a Histological Transformation of ALK-Rearranged Adenocarcinoma With High Expression of PD-L1 to Squamous Cell Carcinoma After Treatment With Alectinib

“…Given that our patient is a never-smoker, EML4 Exon 13 and ALK Exon 20 fusion mutations were detected in the two biopsies at first diagnosis and recurrence, and 80% of the tumor cells in the two specimens showed diffuse and strong positive expression of PD-L1, the tissues after resistance were not likely to originate from an independent new tumor. In addition, primary ALK -positive squamous cell carcinoma often showed a remarkably positive response to alectinib [ 12 , 13 ], but in this case the squamous cell carcinoma was not sensitive to alectinib. Since the patient was taking alectinib for treatment without chemotherapy or radiotherapy, we believe that changes in the initial tumor morphology could be caused by treatment with alectinib.…”

Targeted next-generation sequencing of 50 cancer-related genes in Japanese patients with oral squamous cell carcinoma

“…10 ALK rearrangements in lung squamous cell carcinoma are rare but do exist. [11][12][13] To our knowledge, there have been no reports of analyses of these rearrangements in OSCC. We then performed high-throughput genotyping of 70 variants of ALK, RET, and ROS1 fusion genes (AmpliSeq RNA Lung Cancer Research Fusion Panel).…”

Dramatic response to alectinib in a patient with ALK‐rearranged squamous cell lung cancer

“…8 It is also similar to that of the response case treated with alectinib (>11 months and > 9 months, respectively). 9,16 Our case and these case reports suggest that alectinib has a longer PFS, even in ALK-rearranged SCC than crizotinib.…”

“…The PFS of this case was 9.5 months, which is shorter than the previously reported PFS of adenocarcinoma, but some SCC cases show promising PFS. 9,16 Further accumulation of clinical experience is needed to clarify the effectiveness of ALK-TKI for ALK-rearranged SCC. For the benefit of patients, genetic testing is important, even if the type of pathology is SCC.…”