PMC9280124_01
The treatment scheme and representative CT scan images during treatment. ADC, adenocarcinoma; SD, stable disease; PR, partial response.
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DNA panel (Onco Panscan ) for comprehensive molecular profiling. During the DNA-NGS analysis, the patient received 1 week of chemotherapy with pemetrexed disodium (0.8 g) and nedaplatin (100 mg) and did not show any response ( Figure 1 ). An initial dose of 60 mg was administered for 1 week, followed by a maintenance dose of 180 mg. According to the Response Evaluation Criteria for Solid Tumors 1.1 guidelines, the CT scan indicated a partial response (PR) lasting longer than 22 months, with no noticeable side effects ( Figure 1 ).
Identification of a novel intergenic ALK fusion. (A) Sequence analysis of the intergenic-ALK fusion. Upper panel showed reads of fusion on Integrative Genomic Viewer. Lower panel showed a schematic presentation of breakpoints and the Sanger's sequencing result. (B) FISH analysis showed fused yellow signals (negative signal), single green signals (positive signal), and single red signals (positive signal) in the patient's specimen. (C) Immunohistochemical staining with anti-ALK antibody (D5F3) revealed a high level of ALK protein.
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The DNA sequencing identified a novel ALK fusion with a mutation frequency of 5.3% ( Figure 2A ). ALK break-apart probe (Healthcare, NMPA: 20183400004) ( Figure 2B ). A high level of ALK protein expression was further validated with immunohistochemistry (Ventana ALK (D5F3 ) XP , #3633, Cell Signaling Technology) ( Figure 2C ).