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Vol.58 No.3 contents | Japanese/English |
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- Case Report -
A Case of ALK-rearrangement-positive Lung Adenocarcinoma in Which the Primary Lesion and Gastric Metastasis Showed Different Responses to Alectinib
Masahiro Ishizuka1,2, Junichi Ochi11Department of Respiratory Medicine, Shuuwa General Hospital, Japan, 2Department of Respiratory Medicine, Tokyo Medical and Dental University Hospital, Japan
Background. The guidelines recommend alectinib as the primary therapy for ALK-positive lung cancer; however, it has the same problems with resistance as crizotinib. Meanwhile, gastric metastasis of lung cancer is rare, and there have been no reports of ALK-positive gastric metastatic lesions. We encountered a case in which a patient's primary lesion and gastric metastatic lesion displayed different responses to alectinib. We herein report the case, including the histopathological assessment of the gastric metastatic lesion after alectinib treatment. Case. A 61-year-old man was diagnosed with ALK-rearrangement-positive lung adenocarcinoma (cT2aN3M1c, stage IVB). He was treated with alectinib and the primary lung lesion showed a sustained response for one year. However, the gastric metastatic lesion showed little response during the course of treatment. Gastrointestinal endoscopy performed after 8 months of treatment revealed that the gastric lesion was markedly increased in size and was bleeding continually. The patient underwent total gastrectomy the following month. Immunohistochemical staining revealed that the gastric lesion remained ALK-positive after the acquisition of resistance to alectinib. Conclusion. In this case, the primary lesion and gastric metastatic lesion showed different responses to alectinib. Because immunostaining of the gastric lesion revealed that it remained ALK-positive after the lesion had acquired resistance to alectinib, we hypothesized that the bypass of the signaling pathways might have been related to the development of resistance by the metastatic lesion. The establishment of methods for identifying resistance mechanisms and the development of appropriate therapies based on these results are expected in the future.
key words: Non-small-cell lung carcinoma, ALK, Alectinib, Gastric metastasis, Resistance
Received: February 19, 2018
Accepted: April 9, 2018
JJLC 58 (3): 231-236, 2018
