PMC9660230_01
Imaging evolution of the patient. (A) The baseline computed tomography scan of alectinib treatment. (B) Computed tomography scan of the last follow-up of alectinib treatment.
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CT scan showed multiple supraclavicular and intrapulmonary lymph node metastases ( Figure 1 ). Thereafter, the patient received oral alectinib 600 mg bid as second-line therapy from 5 May 2020, with PR as the best response ( Figure 1 ), and continued to receive clinical benefits from treatment.
(A) Immunohistochemistry confirms the pathological typing of lung adenocarcinoma (x20). (B) Immunohistochemical staining of ALK expression (Ventana anti-ALK D5F3 clones, Roche-Ventana), and the pathologic assessment was positive (x20), localized in the cytoplasm. .
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Immunohistochemistry (IHC) indicated that this lymph node was metastatic lung adenocarcinoma with ALK-positive ( Figure 2 ).
Identification of the ALK-R3HDM1 fusion by next-generation sequencing. (A) Integrated Genomics Viewer snapshot demonstrating the ALK-R3HDM1 translocation. (B) The schematic structure of the genomic DNA sequence shows the ALK-R3HDM1 fusion points.
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Moreover, next-generation sequencing (NGS) approved that ALK-R3HDM1(A19: R21) and EML4-ALK (E6: A20, variant 3) rearrangement coexisted in specimens from the supraclavicular lymph node ( Figure 3 ) without EGFR mutation.
Description of the clinical course and pertinent molecular findings for the patient presented.
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The duration of response (DOR) of alectinib is over 26 months ( Figure 4 ).