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ALK-positive adenocarcinoma after acquired resistance to lorlatinib and transformation to small-cell lung cancer: a case report

  • Author Footnotes
    † These authors have contributed equally to this work as co-first authors
    Huihui Li
    Footnotes
    † These authors have contributed equally to this work as co-first authors
    Affiliations
    The Second Clinical Medical College of Wenzhou Medical University, Wenzhou 325035, Zhejiang, China

    Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer(IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
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  • Author Footnotes
    † These authors have contributed equally to this work as co-first authors
    Tianqi Song
    Footnotes
    † These authors have contributed equally to this work as co-first authors
    Affiliations
    The Second Clinical Medical College of Wenzhou Medical University, Wenzhou 325035, Zhejiang, China

    Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer(IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
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  • Xiaoling Xu
    Correspondence
    Correspondence to: Xiaoling Xu, Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences, (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer(IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.
    Affiliations
    Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer(IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China

    The Second Clinical Medical College of Wenzhou Medical University, Wenzhou 325035, Zhejiang, China
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  • Author Footnotes
    † These authors have contributed equally to this work as co-first authors
Open AccessPublished:January 19, 2023DOI:https://doi.org/10.1016/j.jtocrr.2023.100464
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      Abstract:

      Small cell lung cancer (SCLC) transformation is a phenomenon that is rarely described in anaplastic lymphoma kinase (ALK)-rearranged cancers after treatment with ALK-tyrosine kinase inhibitors (TKIs); however, it is exceedingly rare after lorlatinib use. We report the first case of a patient with an ALK-EML4 rearrangement who was resistant to lorlatinib simply due to transformation to SCLC and rapidly achieved partial response (PR) after traditional etoposide combined with cisplatin therapy. In addition, we provide a fishplot that visualizes tumor evolution based on next-generation sequencing, which may predict small-cell transformation and facilitate early treatment.

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