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Complete response to alectinib in ALK-fusion metastatic salivary ductal carcinoma
Jacob J Adashek1, Surendra Sapkota2, Rodrigo de Castro Luna3
1Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, MD, USA. jadashek@westernu.edu.
Abstract:
The advent of next-generation sequencing (NGS) has allowed for the identification of novel therapeutic targets for patients with uncommon cancers. It is well known that fusion translocations are potent driver of cancer pathogenesis and can render tumors exquisitely sensitive to matching targeted therapies. Here we describe a patient with ALK-fusion positive widely metastatic salivary ductal carcinoma, who achieved a durable complete response from alectinib, a potent and specific ALK tyrosine kinase inhibitor. This case serves as another reminder that ALK-fusions can be targeted regardless of histology and can afford patients dramatic and durable benefit. It also emphasizes the need for insurance coverage for such beneficial therapies. While ALK fusions are exceedingly rare in salivary ductal carcinoma, the presence of multiple other targetable aberrations supports the recommendation for universal NGS testing for such tumors.
Insights
Next-generation sequencing identified an anaplastic lymphoma kinase (ALK) fusion in a patient with metastatic salivary ductal carcinoma. Targeted therapy with alectinib resulted in a durable complete response, highlighting the efficacy of ALK inhibitors.
Area of Science:
- Oncology
- Genetics
- Pharmacology
Background:
- Fusion translocations are key drivers in cancer pathogenesis.
- Targeted therapies can be highly effective against tumors with specific genetic alterations.
- Salivary ductal carcinoma is a rare cancer with limited targeted treatment options.
Purpose of the Study:
- To report a case of ALK-fusion positive salivary ductal carcinoma.
- To demonstrate the efficacy of alectinib in treating this rare cancer.
- To advocate for universal next-generation sequencing (NGS) testing in uncommon cancers.
Main Methods:
- Next-generation sequencing (NGS) for genomic profiling.
- Treatment with alectinib, an ALK tyrosine kinase inhibitor.
- Clinical assessment of treatment response and duration.
Main Results:
- Identification of an anaplastic lymphoma kinase (ALK) fusion in a patient with widely metastatic salivary ductal carcinoma.
- The patient achieved a durable complete response to alectinib therapy.
- The case underscores the potential for dramatic and lasting benefit from targeted ALK inhibition.
Conclusions:
- ALK fusions represent actionable targets in salivary ductal carcinoma, irrespective of histology.
- Universal NGS testing is recommended for salivary ductal carcinoma to identify targetable aberrations.
- Timely insurance coverage for targeted therapies is crucial for patient access to beneficial treatments.
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