A Case of EGFR Mutation and EML4-ALK Mutation-positive Lung Adenocarcinoma That Transformed to Small-cell Lung Cancer After Chemotherapy

Murata Yasunori, Shiroshita Akihiro, Suzuki Hokuto, Nakashima Kiyoshi, Takahashi Kota, Ikebe Dai, Terashima Tsuyoshi, Takeshita Masafumi

doi:10.2482/haigan.61.342

<p>Background. Transformation to small-cell lung cancer (SCLC) has been reported as one of the resistance mechanisms of EGFR-TKI-positive adenocarcinomas, and the transformed tumor has been reported to respond to chemotherapy for SCLC. EGFR gene mutations and ALK fusion gene mutations are considered to be exclusive, and co-positive cases are extremely rare. We herein report a case in which an adenocarcinoma that was co-positive for EGFR gene mutations and ALK fusion gene mutations transformed to SCLC after chemotherapy. Case. Follow-up computed tomography after treatment for Castleman's disease at a previous hospital in a 64-year-old man revealed a nodular shadow and right pleural effusion in the upper right lobe, which was staged as pT4N0M1a (pleural metastasis) stage IV adenocarcinoma. Surgery was performed, and the surgical specimen was positive for EGFR gene mutations and ALK fusion gene mutations. The administration of erlotinib was therefore started. Subsequently, since the tumor became resistant to treatment and was EGFR-T790M-positive, osimertinib was administered. The tumor responded to treatment but then recurred. Many chemotherapy agents were attempted, and he was eventually referred to our hospital for further treatment. A third bronchial lung biopsy was performed, which revealed EGFR gene mutations and ALK fusion gene mutation positivity, as well as SCLC transformation. Amrubicin was administered as the treatment for SCLC and was effective. Conclusion. Our experience suggests that EGFR gene mutation and ALK fusion gene mutation co-positive cases can transform to SCLC after chemotherapy. Co-positive cases themselves are rare, and no instances of co-positive cases that transformed to SCLC after treatment have been previously reported. We therefore reported a rare case of such a transformation. </p>

A Case of EGFR Mutation and EML4-ALK Mutation-positive Lung Adenocarcinoma That Transformed to Small-cell Lung Cancer After Chemotherapy

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