Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China.
Hangzhou Normal University, Hangzhou, China.
Medicine (Baltimore). 2022 Aug 19;101(33):e30094. doi: 10.1097/MD.0000000000030094.
Previous studies have shown that PD-L1 TPS ≥50% in lung cancer rarely overlaps with driver oncogenes such as epidermal growth factor receptor and anaplastic lymphoma kinase (ALK). The initial gene detection of the patient in this study showed ALK fusion combined with high expression of PD-L1. We explored the treatment options for this patient.
A 34-year-old woman presented for the first time with "repeated fever and cough for 20 days." The patient denied any underlying medical history.
After a series of imaging examinations and needle biopsy, the patient was diagnosed as stage IV lung adenocarcinoma with multiple liver and bone metastases (EML4-ALK fusion, PD-L1 TPS 80%).
The patient was initially given alectinib targeted therapy. After progression, a second round of genetic testing was performed and the patient was detected to have both ALK fusion and BRAF mutation. The patient was then successively changed to treatment with ensatinib combined with dabrafenib, and lorlatinib combined with dabrafenib.
The initial efficacy evaluation of alectinib was PR, but its PFS was only 4 months. The patient only achieved an overall survival of 10 months.
Non-small cell lung cancer with an ALK fusion and high PD-L1 expression responds poorly to most current treatment options, with survival time after ALK-tyrosine kinase inhibitor treatment notably shorter than that of patients with an ALK fusion alone.
先前的研究表明，肺癌中 PD-L1 TPS≥50% 很少与驱动癌基因如表皮生长因子受体和间变性淋巴瘤激酶（ALK）重叠。本研究中患者的初始基因检测显示 ALK 融合与 PD-L1 的高表达相结合。我们探索了该患者的治疗选择。
一名 34 岁女性首次出现“反复发热和咳嗽 20 天”。患者否认有任何潜在的病史。
经过一系列影像学检查和针吸活检，患者被诊断为 IV 期肺腺癌，伴有多发肝和骨转移（EML4-ALK 融合，PD-L1 TPS 80%）。
患者最初接受了阿来替尼的靶向治疗。进展后，进行了第二轮基因检测，发现患者既有 ALK 融合又有 BRAF 突变。随后，患者相继接受恩沙替尼联合达布拉非尼、洛拉替尼联合达布拉非尼治疗。
阿来替尼的初始疗效评估为 PR，但 PFS 仅为 4 个月。患者的总生存时间仅为 10 个月。
ALK 融合且 PD-L1 高表达的非小细胞肺癌对大多数当前的治疗选择反应不佳，ALK 酪氨酸激酶抑制剂治疗后的生存时间明显短于单独存在 ALK 融合的患者。
