Lung adenocarcinoma with concurrent KRAS mutation and ALK rearrangement responding to crizotinib: case report

Area of Science:

• Oncology
• Genetics
• Molecular Biology

Background:

• A specific chromosomal translocation involving the echinoderm microtubule-associated protein-like 4 (EML4) and anaplastic lymphoma kinase (ALK) genes is a newly discovered genetic alteration in non-small cell lung cancer (NSCLC).
• EML4-ALK fusions are infrequent and linked to distinct clinicopathological characteristics, including a history of never or light smoking, younger age, and adenocarcinoma with signet ring or acinar histology.
• Existing research indicates that ALK gene rearrangements typically occur independently of EGFR and KRAS mutations.

Observation:

• This report details the first known case of a patient with concurrent KRAS mutation and EML4-ALK translocation.
• The patient presented with clinicopathological features consistent with EML4-ALK-positive NSCLC.
• The patient experienced a significant positive response to crizotinib treatment.

Findings:

• Concurrent KRAS mutation and EML4-ALK translocation can occur in NSCLC.
• EML4-ALK translocation may act as the primary oncogenic driver even in the presence of a KRAS mutation.

Implications:

• This finding expands the understanding of genetic alterations in NSCLC.
• It suggests that patients with concurrent mutations may still benefit from targeted therapies like crizotinib.
• Further research is warranted to explore the clinical significance and therapeutic strategies for such cases.