Alectinib for the treatment of papillary thyroid carcinoma harbouring STRN - ALK fusion

Area of Science:

• Oncology
• Genetics
• Pharmacology

Background:

• Anaplastic Lymphoma Kinase (ALK) rearrangement is a rare genetic alteration in differentiated thyroid carcinomas (DTCs).
• Limited evidence exists regarding the efficacy of ALK inhibitors for advanced DTCs due to the low prevalence of ALK alterations.
• Thyroid cancer treatment remains challenging, particularly for advanced stages with specific genetic drivers.

Purpose of the Study:

• To report the first European case of a patient with a striatin (STRN) - ALK translocated advanced thyroid carcinoma.
• To evaluate the clinical efficacy and tolerability of alectinib in treating this rare molecular subtype of thyroid cancer.
• To highlight the potential of targeted therapy in advanced DTCs with specific genetic rearrangements.

Main Methods:

• Next-generation sequencing (NGS) - RNA analysis was employed to detect the STRN-ALK translocation.
• A 74-year-old female patient with advanced thyroid carcinoma and lung metastases received first-line alectinib treatment.
• Alectinib dosage was adjusted to manage treatment-related toxicity while maintaining therapeutic efficacy.

Main Results:

• The patient achieved a complete radiological response and experienced significant clinical benefit.
• Treatment with alectinib was ongoing for 17 months, with dose reductions due to toxicity.
• The STRN-ALK translocation was successfully identified as the targetable driver mutation.

Conclusions:

• This case represents the first reported instance in Europe of successful treatment for STRN-ALK translocated advanced thyroid carcinoma using alectinib.
• Targeted therapy with ALK inhibitors like alectinib can be effective in managing rare molecular subtypes of advanced DTC.
• Personalized medicine approaches, guided by molecular profiling, are crucial for optimizing outcomes in advanced thyroid cancer.