Colorectal Cancer with EML4-ALK Fusion Gene Response to Alectinib: A Case Report and Review of the Literature

Anti-epithelial growth factor receptor or anti-vascular endothelial growth factor agents combined with chemotherapy were the standard of treatment for metastatic colorectal cancer (CRC). However, increasing evidence of molecularly stratified treatment makes the complexity of treatment. Anaplastic ly...

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Bibliographic Details
Published in:Case reports in oncology 2021-01, Vol.14 (1), p.232-238
Main Authors: Hsiao, Sheng-Yen, He, Hong-Lin, Weng, Teng-Song, Lin, Cheng-Yao, Chao, Chien-Ming, Huang, Wen-Tsung, Tsao, Chao-Jung
Format: Article
Language:English
Subjects:
alk gene alternation
Ascites
Cancer therapies
Case Report
Case reports
Chemotherapy
Clinical medicine
Colonoscopy
Colorectal cancer
FDA approval
Gastrointestinal cancer
Genes
Kinases
Liver
Lung cancer
Lymphoma
Metastasis
Monoclonal antibodies
Mutation
next-generation sequencing
Patients
Stains & staining
Tumors
Vascular endothelial growth factor
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Summary:Anti-epithelial growth factor receptor or anti-vascular endothelial growth factor agents combined with chemotherapy were the standard of treatment for metastatic colorectal cancer (CRC). However, increasing evidence of molecularly stratified treatment makes the complexity of treatment. Anaplastic lymphoma kinase (ALK) gene alternation is one of potential target for biomarker-guided therapy for CRC. We present a case of a 56-year-old man who suffered from advanced ascending colon cancer, harboring echinoderm microtubule associated protein-like 4 (EML4)-ALK fusion gene E21; A20 variant, a rare variant in EML4-ALK fusion gene in lung cancer. We also detected this fusion gene from different tissue types including circulating tumor DNA (ctDNA) and ascites fluid. The patient was offered alectinib, an ALK inhibitor, with partial response in lung, liver, and peritoneal metastasis for 8 months. Tumor heterogeneity, especially in gastrointestinal tract cancer, raise our interest in comprehensive genetic profiling in clinical practice. Convenience and reliability of next-generation sequencing, including using ctDNA, help physicians deal with clinical dilemma. ALK-positive CRC is rare. However, advanced CRC with ALK gene alteration responds to ALK inhibitor. It is reasonable to check ALK gene alteration in clinical practice for CRC.
ISSN:1662-6575
1662-6575
DOI:10.1159/000511069