Neoadjuvant Crizotinib in Advanced Inflammatory Myofibroblastic Tumour with ALK Gene Rearrangement

Abstract

We report a rapid early response to crizotinib as neoadjuvant therapy, enabling surgical excision of a large ALK-translocated IMT, which resulted in complete disease clearance. To the best of our knowledge, this is the first case in the literature of a patient with IMT in whom crizotinib was used successfully in the neoadjuvant or curative setting.

Crizotinib in ALK+ inflammatory myofibroblastic tumors—Current experience and future perspectives

“…However, these studies did not report individual patient data. The median age of the 16 patients included in case reports was 22 years (range 4–71 years), and five patients were younger than 18 years . The median age of the children included in the COG study was 7 years (range 2–13.5 years) …”

“…The median age of the 16 patients included in case reports was 22 years (range 4-71 years), and five patients were younger than 18 years. 14,[25][26][27][28][29][30][31][32][33][34][35][36][37] The median age of the children included in the COG study was 7 years (range 2-13.5 years). 24 Nine of the 16 patients included in case reports had tumors with IMT histology of spindle cell stroma with leukocyte/plasma cell infiltrate, whereas histology of the other seven patients showed a myxoid stroma with round epithelioid cells and a neutrophil infiltrate representing the IMT variant EIMS.…”

An Oncogenic NTRK Fusion in a Patient with Soft-Tissue Sarcoma with Response to the Tropomyosin-Related Kinase Inhibitor LOXO-101

“…Treatment with imatinib results in dramatic tumor shrinkage (24). Similarly, inflammatory myofibroblastic tumors (IMT) harbor fusions involving ALK or ROS1 and treatment with crizotinib results in rapid clinical response (25–27). The only previously known defining TRK fusion in sarcoma is the ETV6-NTRK3 fusion in infantile fibrosarcoma, a locally aggressive but rarely metastasizing mesenchymal tumor exclusively affecting children under the age of one.…”

Off-Label Use of Crizotinib as a Neoadjuvant Treatment for a Young Patient When Conventional Chemotherapy Gave No Benefits in Stage IIIA Non-Small Cell Lung Cancer

“…This is the second case, to our knowledge, reported in the English literature of a patient treated with crizotinib in a neoadjuvant setting for bronchial cancer showing a good tumoral downstaging [ 13 ]. An Irish team also used crizotinib with success as a salvage second-line neoadjuvant treatment on a patient with an advanced inflammatory myofibroblastic tumor, a rare sarcoma with an ALK gene rearrangement, when ifosfamide and doxorubicin had failed [ 14 ].…”