Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Knipe H, Hacking C, Anaplastic lymphoma kinase (ALK) fusion oncogene positive non small cell lung cancer. Reference article, Radiopaedia.org (Accessed on 19 Mar 2024) https://doi.org/10.53347/rID-65353
Disclosures:
At the time the article was last revised Henry Knipe had the following disclosures:
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
These were assessed during peer review and were determined to
not be relevant to the changes that were made.
View Henry Knipe's current disclosures
Anaplastic lymphoma kinase (ALK) fusion oncogene positive non small cell lung cancer (NSCLC) refers to a specific set of non small cell lung cancers that contain an inversion in chromosome 2. They are associated with specific clinical features, including never or light smoking history, younger age, and adenocarcinoma with a signet ring or acinar histology.
4-5% of non small cell lung cancers may be ALK positive ref.
The resulting novel fusion oncogene EML4-ALK rearrangement is transforming both in vitro and in vivo and defines a distinct clinicopathologic subset of NSCLC. ALK gene arrangements are "largely but not entirely" mutually exclusive with epidermal growth factor receptor (EGFR) and KRAS mutations 6.
Since ALK NSCLS is a relatively new discovery (c. 2022) there are not many imaging publications on this topic. Some reported features include:
more central tumor location 1
possible greater lower lobe predilection 10
absence of pleural tail 1
associated large pleural effusion 1
relatively smaller size 2
lower tumor disappearance rate (TDR) rate following treatment 2
may appear as more solid masses with lobulated margins 4
Their metastatic pattern can also be different to those EGFR mutations in than ALK positive tumors maybe have 10:
Treatment and prognosis
They are more responsive to anaplastic lymphoma kinase (ALK) and c-Met receptor kinases, e.g. crizotinib, alectinib.
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2. Nakada T, Okumura S, Kuroda H, Uehara H, Mun M, Takeuchi K, Nakagawa K. Imaging Characteristics in ALK Fusion-Positive Lung Adenocarcinomas by Using HRCT. (2015) Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 21 (2): 102-8. doi:10.5761/atcs.oa.14-00093 - Pubmed
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4. Choi CM, Kim MY, Hwang HJ, Lee JB, Kim WS. Advanced adenocarcinoma of the lung: comparison of CT characteristics of patients with anaplastic lymphoma kinase gene rearrangement and those with epidermal growth factor receptor mutation. (2015) Radiology. 275 (1): 272-9. doi:10.1148/radiol.14140848 - Pubmed
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5. O'Bryant CL, Wenger SD, Kim M, Thompson LA. Crizotinib: a new treatment option for ALK-positive non-small cell lung cancer. (2013) The Annals of pharmacotherapy. 47 (2): 189-97. doi:10.1345/aph.1R002 - Pubmed
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6. Baldi L, Mengoli MC, Bisagni A, Banzi MC, Boni C, Rossi G. Concomitant EGFR mutation and ALK rearrangement in lung adenocarcinoma is more frequent than expected: report of a case and review of the literature with demonstration of genes alteration into the same tumor cells. (2014) Lung cancer (Amsterdam, Netherlands). 86 (2): 291-5. doi:10.1016/j.lungcan.2014.09.011 - Pubmed
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7. Toyokawa G, Seto T. Anaplastic lymphoma kinase rearrangement in lung cancer: its biological and clinical significance. (2014) Respiratory investigation. 52 (6): 330-8. doi:10.1016/j.resinv.2014.06.005 - Pubmed
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8. Arbour KC, Riely GJ. Diagnosis and Treatment of Anaplastic Lymphoma Kinase-Positive Non-Small Cell Lung Cancer. (2017) Hematology/oncology clinics of North America. 31 (1): 101-111. doi:10.1016/j.hoc.2016.08.012 - Pubmed
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9. Lin J, Jiang G, Joshipura N et al. Efficacy of Alectinib in Patients with ALK-Positive NSCLC and Symptomatic or Large CNS Metastases. J Thorac Oncol. 2019;14(4):683-90. doi:10.1016/j.jtho.2018.12.002 - Pubmed
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10. Mendoza D, Lin J, Rooney M et al. Imaging Features and Metastatic Patterns of Advanced ALK-Rearranged Non–Small Cell Lung Cancer. AJR Am J Roentgenol. 2020;214(4):766-74. doi:10.2214/ajr.19.21982 - Pubmed
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