A case of ALK-rearranged non-small cell lung cancer that responded to ceritinib after development of resistance to alectinib

// Yosuke Makuuchi 1, 2 , Hidetoshi Hayashi 1 , Koji Haratani 1 , Junko Tanizaki 1 , Kaoru Tanaka 1 , Masayuki Takeda 1 , Kazuko Sakai 3 , Shigeki Shimizu 4 , Akihiko Ito 4 , Kazuto Nishio 3 and Kazuhiko Nakagawa 1 1 Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan 2 Department of Hematology, Graduate School of Medicine, Osaka City University, Abeno, Osaka 545-8585, Japan 3 Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan 4 Department of Pathology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan Correspondence to: Hidetoshi Hayashi, email: hidet31@med.kindai.ac.jp Keywords: non–small cell lung cancer (NSCLC); L1196M; anaplastic lymphoma kinase (ALK) fusion gene; ceritinib; alectinib Received: December 26, 2017 Accepted: April 02, 2018 Published: May 01, 2018 ABSTRACT The second-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) alectinib and ceritinib are standard treatment options for patients with non–small cell lung cancer (NSCLC) positive for ALK fusion genes. However, almost all patients eventually develop resistance to these drugs. We here report a case of ALK -rearranged NSCLC that developed resistance to alectinib but remained sensitive to ceritinib. The L1196M mutation within the ALK fusion gene was detected after failure of consecutive treatment with crizotinib and alectinib, but no other mechanism underlying acquired resistance to ALK-TKIs was found to be operative. Given the increasing application of ALK-TKIs to the treatment of patients with ALK -rearranged NSCLC, further clinical evaluation is warranted to provide a better understanding of the mechanisms of acquired resistance to these agents and to inform treatment strategies for such tumors harboring secondary mutations.