Clinicopathologic Characteristics and Outcomes of Patients with Anaplastic Lymphoma Kinase-Positive Advanced Pulmonary Adenocarcinoma: Suggestion for an Effective Screening Strategy for These Tumors

Abstract

The clinical outcomes of platinum-based chemotherapy were found not to differ according to the ALK status. Both smokers and never/light smokers should be candidates for ALK screening. We suggest that the exclusion of patients with activating EGFR mutations, an objective response to previous EGFR TKIs, or TTF-1-negative tumors from ALK screening could be an effective enrichment strategy for ALK-positive cases.

Clinical outcome for EML4-ALK-positive patients with advanced non-small-cell lung cancer treated with first-line platinum-based chemotherapy

“…Although several studies have evaluated the efficacy of cytotoxic chemotherapy based on the molecular profile of the disease, classified as EML4-ALK positive, EGFR mutation positive, or wild type for both types of genetic abnormality [10,[12][13][14][15], it has remained unclear whether EML4-ALK is an effective prognostic factor [13][14][15]. Further studies are thus warranted to determine the impact of EML4-ALK on the survival of patients treated with cytotoxic chemotherapy.…”

Fluorescence In Situ Hybridization, Immunohistochemistry, and Next-Generation Sequencing for Detection of EML4-ALK Rearrangement in Lung Cancer

“…Analysis of the Israeli cohort shows that this rearrangement is most common in young men, and the chances for finding the fusion are reduced by 7% with each additional year in a lung cancer patient aged .52 years [12]. Even with the proposed characteristics, the current International Association for the Study of Lung Cancer (IASLC) guidelines state, "ALK molecular testing should be used to select patients for ALKtargeted tyrosine kinase inhibitor (TKI) therapy and patients with lung adenocarcinoma should not be excluded from testing on the basis of clinical characteristics" [13][14][15]. The prevalence of EML4-ALK rearrangement in an unselected non-small cell lung cancer (NSCLC) population is 3.4% (range: 1.6%-11.7%), whereas in the adenocarcinoma subset of NSCLC, the prevalence of EML4-ALK rearrangement is 4.5% (range: 2.4%-16.1%) [16].…”

Precision Medicine for Lung Cancer: Role of the Surgical Pathologist

“…Although ALK þ lung cancers are associated with certain clinical features, such as a light or never smoker history, there are sufficient exceptions to these clinical features to exclude patients from ALK testing who might otherwise benefit from ALK inhibitor treatment. 22 Therefore, clinical features, while possibly suggestive, are not generally preferred for selecting patients for ALK testing. 21 The ALK rearrangements are associated with adenocarcinoma cell type, which is a diagnosis that is made by the surgical pathologist and is currently a basis for sending tissue for ALK testing.…”