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Gingival Metastasis of ALK Rearranged Non-Small Cell Lung Cancer
Rui Kitadai1, Yusuke Okuma1, Jumpei Kashima2
1Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Background:
Metastasis to oral soft tissues is rare and account for only 0.1% of all oral malignancies. Oral cavity metastasis tends to be male-predominant, and lung cancer is the leading cause. Targeted therapies for advanced ALK rearranged non-small cell lung cancer (NSCLC) have shown a promising higher response than cytotoxic chemotherapy. Gingival metastasis usually shows poor prognosis. However using ALK inhibitor to ALK-positive advanced NSCLC may show longer survival.
Case:
A 64-year-old male who was diagnosed non-small cell carcinoma (NSCC) favoring adenocarcinoma presented with gingival metastasis. After first-line chemotherapy, ALK rearrangement was revealed in both primary lesion and gingival metastasis, and therefore the patient was treated with alectinib. Tumor response of the primary site and gingival lesion were obtained, however he presented with intestinal metastasis that lead to bowel obstruction and passed away.
Conclusion:
Our case showed good response to primary tumor and gingival metastasis but not to intestinal obstruction. ALK inhibitor often shows high response rate and long survival for ALK rearrangement NSCLC, however ALK rearranged positive NSCLC with gingival metastasis may have poor prognosis.
Insights
Metastasis to the oral cavity from non-small cell lung cancer (NSCLC) is rare. While ALK inhibitors show promise for ALK-positive NSCLC, gingival metastasis may still indicate a poor prognosis.
Area of Science:
- Oncology
- Oral Pathology
- Genetics
Background:
- Oral soft tissue metastasis is rare, comprising 0.1% of oral malignancies, predominantly in males, with lung cancer as the leading primary source.
- Advanced anaplastic lymphoma kinase (ALK) rearranged non-small cell lung cancer (NSCLC) shows better response to targeted therapies than traditional chemotherapy.
- Gingival metastasis typically portends a poor prognosis, although ALK inhibitors may prolong survival in ALK-positive NSCLC.
Observation:
- A 64-year-old male with non-small cell carcinoma (NSCC) presented with gingival metastasis.
- ALK rearrangement was identified in both the primary tumor and gingival metastasis after initial chemotherapy.
- The patient received alectinib, achieving tumor response in the primary and gingival sites, but ultimately succumbed to intestinal metastasis causing obstruction.
Findings:
- The case demonstrated a positive response to alectinib for both the primary NSCLC and gingival metastasis.
- Despite initial treatment success, the patient developed fatal intestinal metastasis.
- This highlights that while ALK inhibitors are effective for ALK-rearranged NSCLC, gingival metastasis may still signify a poor overall prognosis.
Implications:
- Targeted therapy with ALK inhibitors can be effective against oral metastases in ALK-positive NSCLC.
- Gingival metastasis in ALK-positive NSCLC, even with targeted therapy, may be associated with a poor prognosis due to potential for distant spread.
- Further research is needed to understand prognostic factors and optimize treatment strategies for rare metastatic presentations of NSCLC.
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