一个新型的二次ALK基因突变,该基因对第二代TKI具有抗性:一个案例报告和文献综述
Xiaqin Cheng1, Jia Liu2, Qiongxia Hu3
1Thoracic Oncology Ward, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
经过EML4-ALK融合的高级非小细胞肺癌 (NSCLC) 可能会由于二次突变而对ALK氨酸激酶抑制剂 (TKI) 产生耐药性. 一种新的E803Q突变对第二代TKIs产生了耐药性,这表明洛拉提尼布是潜在的治疗方法.
科学领域:
- 在瘤学瘤学.
- 分子生物学分子生物学
- 遗传学 是一个遗传学.
背景情况:
- 具有EML4-ALK基因融合的腺癌占肺癌的3-7%,可被ALK氨酸激酶抑制剂 (TKIs) 向.
- 第二代TKI是ALK阳性NSCLC的标准,包括中枢神经系统转移的NSCLC.
- 药物耐药性,主要来自二次突变,导致大多数患者的疾病进展.
研究的目的:
- 报告一个先进的非小细胞肺癌 (NSCLC) 病例,该病例与EML4-ALK融合发展了对一线alectinib的耐药性.
- 识别导致TKI耐药性的新型二次突变.
- 为了评估后续TKI治疗的疗效.
主要方法:
- 下一代测序 (NGS) 用于检测一个患有晚期NSCLC和EML4-ALK融合的患者的二次突变.
- 患者接受了alectinib,ensartinib和ceritinib的连续治疗.
主要成果:
- 疾病进展发生在一线alectinib治疗3个月内.
- 确定了两个二次突变,V1180L和14号外体中的新型E803Q突变.
- 随后使用恩萨尔提尼布和谢里替尼布的治疗显示出反应不佳,总生存期仅为7个月.
结论:
- 新的E803Q突变似乎会对大多数第二代ALK-TKI产生抗性.
- 对患有这种突变的患者来说,检测第三代ALK-TKI lorlatinib的疗效是有必要的.
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