Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2022; 10(33): 12164-12174
Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12164
Coexistence of anaplastic lymphoma kinase rearrangement in lung adenocarcinoma harbouring epidermal growth factor receptor mutation: A single-center study
Wei-Xiang Zhong, Xi-Feng Wei
Wei-Xiang Zhong, Department of Thoracic Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
Wei-Xiang Zhong, First Clinical Medical College, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Xi-Feng Wei, Department of Outpatient, Ganzhou Maternity and Child Health Hospital, Ganzhou 341000, Jiangxi Province, China
Author contributions: Zhong WX contributed to conception and design, data analysis and interpretation; Zhong WX and Wei XF collected and assembled the data, wrote the manuscript, and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Scientific Research Ethics Committee of the First Affiliated Hospital of Gannan Medical University (Approval No. LLSC-2021081601).
Informed consent statement: Patients were not required to give informed consent to the study, because the data used in this study were all anonymous, which were not involved in the patients’ privacy information, they were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at bronco067@126.com. The data used in this study were all anonymous, which were not involved in the patients’ privacy information, they were obtained after each patient agreed to treatment by written consent.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Xiang Zhong, MA, Attending Doctor, Surgeon, Department of Thoracic Surgery, First Affiliated Hospital of Gannan Medical University, No. 128 Jinling West Road, Ganzhou 341000, Jiangxi Province, China. bronco067@126.com
Received: August 7, 2022
Peer-review started: August 7, 2022
First decision: September 25, 2022
Revised: October 4, 2022
Accepted: October 24, 2022
Article in press: October 24, 2022
Published online: November 26, 2022
Processing time: 107 Days and 21.1 Hours
Abstract
BACKGROUND

Accumulating evidences confirm that epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement have coexisted in lung adenocarcinoma (LUAD). However, Its biological mechanism, clinicopathological features, and optimization of targeted drugs have not yet been completely elucidated.

AIM

To explore the clinical profile of LUAD patients with co-mutations of EGFR and ALK genes, with hopes of scientifically guiding similar patients towards selected, targeted drugs.

METHODS

Two hundred and thirty-seven LUAD patients were enrolled. EGFR mutations were detected by the amplification refractory mutation system-peptide nucleic acid technique, while the expression of ALK rearrangement was screened by the 5′/3′ imbalance strategy for reverse transcription followed by quantitative polymerase chain reaction analysis. The clinicopathological features of these patients were analysed retrospectively, and the follow-up data were collected.

RESULTS

There were six cases with co-mutations of EGFR and ALK genes, which were more common in women, non-smoking and stage IV LUAD patients with bone metastasis, hence a positive rate of 2.53% (6/237). EGFR-tyrosine kinase inhibitors (EGFR-TKIs) were their preferred drugs for targeted therapy in these patients, with progression-free survival ranging from two months to six months.

CONCLUSION

In Gannan region, the positive rate of co-mutations of EGFR and ALK genes in LUAD patients is relatively high, and the co-mutations are more common in women, non-smoking and stage IV patients with bone metastasis. These patients prefer EGFR-TKIs as their preferred targeted drugs, but the therapeutic effect is not good. EGFR/ALK dual-TKIs may be more effective targeted drugs, which needs further study.

Keywords: Lung adenocarcinoma; Epidermal growth factor receptor mutation; Anaplastic lymphoma kinase rearrangement; Co-mutation; Tyrosine kinase inhibitor

Core Tip: This study retrospectively analyzed the clinicopathological features of patients with co-mutations of EGFR and ALK genes in lung adenocarcinoma, and collected follow-up data of these patients, especially focusing on the tyrosine kinase inhibitors (TKIs) selected and its therapeutic effect in the real world from a single institute experience. The results showed that the positive rate of lung adenocarcinoma patients with co-mutations of EGFR and ALK genes, which were more common in women, non-smoking and stage IV patients with bone metastasis, was relatively high in Gannan region, which may be related to regional heterogeneity. EGFR-TKIs were their preferred drugs for targeted therapy in these patients, but the therapeutic effect is not good. EGFR/ALK dual-TKIs may be more effective targeted drugs.