Anaplastic lymphoma kinase (ALK) fusion oncogene positive non small cell lung cancer

Last revised by Henry Knipe on 22 Dec 2022

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:

They are more responsive to anaplastic lymphoma kinase (ALK) and c-Met receptor kinases, e.g. crizotinib, alectinib.

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