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Case report: ATIC-ALK fusion in infant-type hemispheric glioma and response to lorlatinib
Shubin W Shahab1,2, Matthew Schniederjan3,4, Jose Velazquez Vega3,4
1Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States.
Introduction:
Infant type hemispheric gliomas are a rare tumor with unique molecular characteristics. In many cases these harbor mutations in receptor tyrosine kinase pathways and respond to targeted therapy. Here we describe the case of an infant with this type of tumor with a novel ATIC-ALK fusion that has responded dramatically to the ALK inhibitor lorlatinib, despite being refractory to standard chemotherapy.
Case Description:
The infant was initially treated with standard chemotherapy and found to have an ATIC-ALK fusion. When surveillance imaging revealed progressive disease, the patient was switched to the ALK-inhibitor lorlatinib at 47 mg/m2/day. The patient demonstrated a significant clinical and radiographic response to the ALK inhibitor lorlatinib after just 3 months of treatment and a near complete response by 6 months of therapy.
Conclusion:
The ALK inhibitor lorlatinib is an effective targeted therapy in infant type hemispheric glioma patients harboring ATIC-ALK fusion.
Insights
Infant hemispheric gliomas with ATIC-ALK fusion show dramatic response to lorlatinib. This targeted therapy offers a new hope for patients refractory to standard chemotherapy.
Area of Science:
- Pediatric neuro-oncology
- Molecular oncology
- Genomic medicine
Background:
- Infant type hemispheric gliomas are rare brain tumors in infants.
- These tumors often possess unique molecular alterations, particularly in receptor tyrosine kinase pathways.
- Targeted therapies are increasingly important for treating these challenging pediatric neoplasms.
Observation:
- A case study of an infant diagnosed with hemispheric glioma harboring a novel ATIC-ALK fusion.
- The tumor was initially refractory to standard chemotherapy regimens.
- Disease progression was observed despite conventional treatment approaches.
Findings:
- The infant presented with a unique ATIC-ALK fusion.
- Treatment with the ALK inhibitor lorlatinib led to significant clinical and radiographic improvement.
- A near-complete response was achieved within six months of targeted therapy initiation.
Implications:
- Lorlatinib demonstrates efficacy as a targeted therapy for infant hemispheric gliomas with ATIC-ALK fusion.
- This finding highlights the potential of precision medicine in pediatric brain tumors.
- Targeted inhibition of ALK may represent a viable therapeutic strategy for this specific molecular subtype.
