Anaplastic lymphoma kinase (ALK) fusion oncogene positive non small cell lung cancer
Anaplastic lymphoma kinase (ALK) fusion oncogene positive non small cell lung cancer 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.
It may account for 4-5 % of non small cell lung cancers.
They resulting in the 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 it is a new discovery there are not many imaging publications on this topic (i.e. one or two studies per finding). Some reported features include:
- more central tumor location 1
- 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
Treatment and prognosis
They are more responsive to anaplastic lymphoma kinase (ALK) and c-Met receptor kinases such as crizotinib.
- 1. Yamamoto S, Korn RL, Oklu R, Migdal C, Gotway MB, Weiss GJ, Iafrate AJ, Kim DW, Kuo MD. ALK molecular phenotype in non-small cell lung cancer: CT radiogenomic characterization. (2014) Radiology. 272 (2): 568-76. doi:10.1148/radiol.14140789 - Pubmed
- 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
- 3. Bang YJ. Treatment of ALK-positive non-small cell lung cancer. (2012) Archives of pathology & laboratory medicine. 136 (10): 1201-4. doi:10.5858/arpa.2012-0246-RA - Pubmed
- 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
- 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
- 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
- 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
- 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