PMC9530790_01
Course of management for (A) patients 1 and (B) 2 and representative imaging findings by brain MRI and pulmonary and liver CT scans since the start of ALK-targeted therapy. Red arrowheads indicate lesions. CT, computed chromatography. MRI, magnetic resonance imaging. PD, progressive disease. PR, partial response. Red arrowheads indicate brain lesions detected on MRI.
fonc-12-915502-g001.jpg
PMC9530790_02_fonc-12-915502-g001.jpg
f1
PE, and multiple hyperdense lymph nodes in the mediastinum and bilateral hila ( Figure 1B ). Pathologic review of the pleural drainage suggested poorly differentiated lung adenocarcinoma, which was subsequently found positive for ALK rearrangement by amplification-refractory mutation system - polymerase chain reaction (ARMS-PCR). Crizotinib was accordingly started and achieved a PFS of 25 months, when imaging studies showed an enlarged mediastinal lymph node (1.9 cm) and multiple enhancing foci in the brain and the T12 and L4 vertebrae ( Figure 1B ). Figure 1B ). Follow-up brain MRI in December showed intracranial progression manifested as newly emerged enhanced foci in the parietal, frontal, and left occipital lobe and cerebellum.
Integrative Genomics View snapshots showing the ALK C1156F missense mutation identified by next-generation sequencing from (A) patient 1 and (B) patient 2.
fonc-12-915502-g002.jpg
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f2
Genomic profiling of the blood revealed EML4-ALK fusion (E13:A20) and ALK C1156F (VAF 2.04%;  Figure 2B ), and the patient was placed on alectinib (600 mg BID) for second-line treatment in Sep 2020.
PMC9530790_02
Course of management for (A) patients 1 and (B) 2 and representative imaging findings by brain MRI and pulmonary and liver CT scans since the start of ALK-targeted therapy. Red arrowheads indicate lesions. CT, computed chromatography. MRI, magnetic resonance imaging. PD, progressive disease. PR, partial response. Red arrowheads indicate brain lesions detected on MRI.
fonc-12-915502-g001.jpg
PMC9530790_02_fonc-12-915502-g001.jpg
f1
PE, and multiple hyperdense lymph nodes in the mediastinum and bilateral hila ( Figure 1B ). Pathologic review of the pleural drainage suggested poorly differentiated lung adenocarcinoma, which was subsequently found positive for ALK rearrangement by amplification-refractory mutation system - polymerase chain reaction (ARMS-PCR). Crizotinib was accordingly started and achieved a PFS of 25 months, when imaging studies showed an enlarged mediastinal lymph node (1.9 cm) and multiple enhancing foci in the brain and the T12 and L4 vertebrae ( Figure 1B ). Figure 1B ). Follow-up brain MRI in December showed intracranial progression manifested as newly emerged enhanced foci in the parietal, frontal, and left occipital lobe and cerebellum.
Integrative Genomics View snapshots showing the ALK C1156F missense mutation identified by next-generation sequencing from (A) patient 1 and (B) patient 2.
fonc-12-915502-g002.jpg
PMC9530790_02_fonc-12-915502-g002.jpg
f2
Genomic profiling of the blood revealed EML4-ALK fusion (E13:A20) and ALK C1156F (VAF 2.04%;  Figure 2B ), and the patient was placed on alectinib (600 mg BID) for second-line treatment in Sep 2020.