Co-Occurrence of ALK rearrangement and KRAS G12C mutation in NSCLC: Report of two cases

IF 0.2 Q4 ONCOLOGY
M Siringo , F Larocca , A Spagnuolo , G Gentile , M Anile , D Diso , D Santini , A Gelibter
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引用次数: 0

Abstract

In the last few years, non-small cell lung cancer (NSCLC) treatment has totally revolutionized by the improvement in molecular diagnostics and the introduction of targeted therapies, becoming the standard of care in patients with actionable alterations. Mostly, genomic mutations are mutually exclusive although some cases of co-occurring actionable alterations could be discovered, especially with the recent introduction of genomic sequencing by next generation sequencing (NGS). Few data are available in the treatment of these particular cases. The co-occurring RAS G12C mutation seems to be a poor prognostic factor in patients with ALK rearranged NSCLC. We report two cases of women with diagnosis of advanced adenocarcinoma oncogene addicted with ALK rearrangement and KRAS G12C mutation. In both cases the PD-L1 status was high (> 50 %). Although both received Alectinib as ALK inhibitor, the lesion rapidly progressed. The patients had benefit only by treatments with chemotherapy, while anti PD-1/PD-L1 axis inhibitors seemed to be inefficient. Precise diagnostic techniques allow the detection of concomitant driver alterations; therefore, oncologists should consider these rare double mutations in NSCLC patients. Further prospective study is still warranted to investigate the role of co-occurring driver alterations and the relevant treatment paradigm

在 NSCLC 中同时出现 ALK 重排和 KRAS G12C 突变:两个病例的报告
在过去几年里,随着分子诊断技术的改进和靶向疗法的引入,非小细胞肺癌(NSCLC)的治疗发生了翻天覆地的变化,已成为可作用基因突变患者的标准治疗方法。大多数情况下,基因组突变是相互排斥的,但也有可能发现一些同时存在可操作改变的病例,尤其是最近采用新一代测序技术(NGS)进行基因组测序之后。治疗这些特殊病例的数据很少。共存的 RAS G12C 突变似乎是 ALK 重排 NSCLC 患者的不良预后因素。我们报告了两例诊断为晚期腺癌的女性患者,她们的癌基因上瘾并伴有ALK重排和KRAS G12C突变。两例患者的PD-L1状态都很高(50%)。虽然两人都接受了作为 ALK 抑制剂的阿来替尼治疗,但病情迅速恶化。患者只能通过化疗获益,而抗PD-1/PD-L1轴抑制剂似乎效果不佳。精确的诊断技术可以检测到并发的驱动基因改变;因此,肿瘤学家应该考虑NSCLC患者中的这些罕见的双重突变。仍有必要开展进一步的前瞻性研究,以探究并发驱动基因改变的作用以及相关的治疗模式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.40
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0.00%
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审稿时长
96 days
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