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Acquired ROS1 fusion and iruplinalkib response in advanced NSCLC after multiple lines of systematic therapy: a case
Jiarui Liu1,2, Zhichao Jiao1,2, Jun Zhou1
1Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Abstract:
This is the first report of a patient with lung cancer whose primary focus was the upper lobe of the left lung combined with multiple metastases in both lungs, initially diagnosed as a non-driver gene mutation, who subsequently developed SDC4-ROS1 fusion after multiple lines of systemic therapy. When diagnosis, a needle biopsy of the primary focus revealed no driver gene mutation and low PD-L1 expression (TPS < 1%, CPS 3). From November 2022 to December 2023, the patient received sequential chemotherapy-based systemic therapy including anti-angiogenesis treatment, concurrent chemoradiation and combined immunotherapy as determined by the clinician based on the initial evaluation. In December 2023, a needle biopsy of a metastasis in the left lower lobe of the lung showed a positive SDC4-ROS1 fusion. Subsequent treatment with the oral ALK TKI iruplinalkib was initiated based on the patient's preference, which exhibited a promising response over the next 2 months.
Insights
This case study details a lung cancer patient who developed a rare SDC4-ROS1 fusion after initial non-driver mutation diagnosis and extensive treatment. The patient showed promising response to targeted therapy with iruplinalkib.
Area of Science:
- Oncology
- Molecular Diagnostics
- Genomics
Background:
- Lung cancer diagnosis and treatment landscape.
- Importance of molecular profiling in non-small cell lung cancer (NSCLC).
- Challenges in treating advanced NSCLC with initially unidentified driver mutations.
Observation:
- A patient with left upper lobe lung cancer and bilateral metastases initially presented with no driver mutations and low PD-L1 expression.
- The patient underwent multiple lines of therapy including chemotherapy, anti-angiogenesis, chemoradiation, and immunotherapy.
- A subsequent biopsy revealed a novel SDC4-ROS1 fusion in a metastatic lesion.
Findings:
- The emergence of a SDC4-ROS1 fusion after extensive prior treatment.
- Successful targeted therapy with an ALK tyrosine kinase inhibitor (TKI), iruplinalkib, in a patient with SDC4-ROS1 fusion.
- Demonstration of treatment response to iruplinalkib over two months.
Implications:
- Highlights the potential for driver gene alterations to emerge during cancer progression.
- Suggests SDC4-ROS1 fusion as a targetable alteration in NSCLC.
- Underscores the value of re-biopsy and molecular testing in refractory lung cancer cases.
- Provides a potential new therapeutic avenue for patients with this rare fusion.
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