Close Menu

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



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. 

25 May, 2016
PDF Attachment: 
e-Published: 06 Jul, 2016


Manuscripts that are Published Ahead of Print have been peer reviewed and accepted for publication by the Editorial Board of the West Indian Medical Journal. They may appear in their original format and may not be copy edited or formatted in the style guide of this Journal. While accepted manuscripts are not yet assigned a volume, issue or page numbers, they can be cited using the DOI and date of e-publication. See our Instructions for Authors on how to properly cite manuscripts at this stage. The contents of the manuscript may change before it is published in its final form. Manuscripts in this section will be removed once they have been issued to a volume and issue, but will still retain the DOI and date of e-publication.

Top of Page