Publication: ALK-rearranged pulmonary adenocarcinoma in Thai Patients: From diagnosis to treatment efficacy
Issued Date
2016
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Language
eng
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Mahidol University
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BioMed Central
Bibliographic Citation
World Journal of Surgical Oncology. Vol. 14, (2016), 139
Suggested Citation
Pimpin Incharoen, Thanyanan Reungwetwattana, Sakditad Saowapa, Kaettipong Kamprerasart, Duangjai Pangpunyakulchai, Lalida Arsa, Artit Jinawath ALK-rearranged pulmonary adenocarcinoma in Thai Patients: From diagnosis to treatment efficacy. World Journal of Surgical Oncology. Vol. 14, (2016), 139. doi:10.1186/s12957-016-0893-6 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/2722
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Title
ALK-rearranged pulmonary adenocarcinoma in Thai Patients: From diagnosis to treatment efficacy
Abstract
Background: Anaplastic lymphoma kinase (ALK) gene rearrangement is detected in 3 % to 13 % of non-small cell
lung carcinoma patients, and these patients benefit from ALK inhibitors. The aim of this study was to determine the
prevalence, the clinical and histological characteristics and the treatment outcomes of ALK-rearranged lung
adenocarcinoma using immunohistochemistry (IHC) IHC, reverse transcription polymerase chain reaction (RT-PCR)
and fluorescence in situ hybridization (FISH) methodologies.
Methods: A total of 268 pulmonary adenocarcinoma patients were screened for ALK expression by ALK IHC, which
was confirmed by FISH and/or RT-PCR for ALK gene rearrangement. The treatment outcomes of ALK-rearranged
patients were retrospectively reviewed.
Results: ALK gene rearrangement was identified in 26 cases (9.7 %) with no EGFR co-mutation, and it showed
significant associations with younger age, female sex and non-smoker status (p < 0.05). A cribriform growth pattern
was identified as the dominant histologic feature, and a solid signet ring cell component was focally present in a
minority of the cases. Among 12 ALK-rearranged patients with conventional treatment, seven cases in the early
stage of disease were cured and alive, and five patients in the late stage of the disease progressed and died, with a
median overall survival (OS) at 14 months. Of the 14 patients receiving crizotinib, all of them had clinical benefit
from crizotinib treatment, with one patient having a complete response (CR), 12 patients having a partial response
(PR) and one patient having stable disease (SD). On the cutoff date, six of 14 patients were continuing crizotinib
treatment with a median time of response of 7.5 (3–13) months, while eight patients had disease progression, and
five of them died with a median OS at 8 months.
Conclusion: ALK gene rearrangement tended to occur in younger, non-smoking, female patients. ALK IHC is a
reliable screening method to detect ALK gene rearrangement. Crizotinib therapy provided treatment benefit in ALKrearranged
adenocarcinoma patients especially in advanced stages of the disease.