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Thoracic SMARCA4-Deficient Undifferentiated Tumor With ALK Fusion Treated With Alectinib Achieved Remarkable Tumor

Jin Sheng1,2, Weidong Han1,2, Hongming Pan1,2

  • 1Department of Medical Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China.

JTO Clinical and Research Reports
|March 27, 2023
PubMed

Insights

SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a lung cancer subtype. This case reveals a rare ALK rearrangement in SMARCA4-UT, leading to a complete response with alectinib therapy.

Area of Science:

  • Oncology
  • Genetics
  • Thoracic Cancer Research

Background:

  • SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is an emerging lung cancer subtype.
  • SMARCA4-UT is typically associated with smoking-related mutations (e.g., KRAS, STK11), not EGFR or ALK alterations.
  • Currently, no specific precision therapy exists for SMARCA4-UT.

Observation:

  • A rare case of a nonsmoking female with thoracic cancer presenting with concomitant ALK rearrangement and SMARCA4 (BRG1) deficiency.
  • The patient received first-line alectinib therapy.

Findings:

  • Alectinib treatment resulted in a remarkable complete response in the patient.
  • This case represents the first documented instance of ALK rearrangement in SMARCA4-UT.

Implications:

  • Highlights the importance of identifying ALK rearrangements in SMARCA4-UT.
  • Suggests potential for targeted therapy (e.g., alectinib) in specific SMARCA4-UT cases.
  • Broadens understanding of the molecular landscape and therapeutic vulnerabilities in SMARCA4-UT.
Keywords:
ALK-rearrangedCase reportNon–small cell lung cancerTargeted therapyThoracic SMARCA4-deficient undifferentiated tumor

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