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Which Tyrosine Kinase Inhibitor we must Apply before?: A Case Report of Crizotinib-Resistant Patient with Concomitant EGFR and EML4-ALK Gene Mutations

DOI: 
10.7727/wimj.2016.096

ABSTRACT

The concomitant epidermal growth factor receptor  (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocations in lung adenocancers are a very rare scenario. Until now, forty two cases described in the literature have all been treated by different drugs. There is no overall consensus regarding the treatment for this adenocarcinoma subgroup.

We report here a case of lung adenocarcinoma with concomitant EGFR mutation in exon 21 (L858R) and ALK rearrangement in primary tumor while EGFR mutation in exon 21 (L858R) and no ALK rearrangement in its synchronous metastasis. We treated this patient with crizotinib as the second line therapy (after the first line docetaxel-cisplatin chemotherapy), but no response was obtained.

The therapeutic choice for the lung adenocancer patients with concomittant EGFR mutation and ALK rearrengement is unclear. Examination of ROS1 mutation can be used as an indicator in the prediction of the crizotinib treatment success. The ALK mutation may not responsible for the resistance to EFGR-TKI, and EGFR-TKI can be initiated to EGFR and ALK dual mutant patients as the first treatment. 

Accepted: 
25 May, 2016
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e-Published: 06 Jul, 2016

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