2022 World Conference on Lung Cancer (ePosters)-EP14.01-001. SCLC Transformation from ALK-rearranged Lung Adenocarcinoma after Alectinib Resistance and Response to Atezolizumab: Case Report

EP14.01-001. SCLC Transformation from ALK-rearranged Lung Adenocarcinoma after Alectinib Resistance and Response to Atezolizumab: Case Report

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This case report describes a unique case of a patient with ALK-rearranged adenocarcinoma who underwent small-cell transformation after treatment with the drug alectinib. Small-cell lung cancer (SCLC) transformation is a known mechanism of acquired resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy, but it is extremely rare in ALK-rearranged adenocarcinomas. The patient initially responded well to alectinib, but after 11 months of treatment, brain metastases progressed. The patient underwent whole brain radiotherapy followed by continued oral alectinib, but metastatic progression occurred one month later. Further examination revealed lymph node metastasis and other complications, and a biopsy confirmed the presence of EML4-ALK rearrangement. <br /><br />As a next step, the patient was treated with the drug atezolizumab in combination with etoposide and carboplatin. This treatment resulted in a significant reduction in the size of the neck mass and a partial response, as shown by CT scan. However, the patient eventually died in April 2021, likely due to refusal to continue treatment.<br /><br />This case highlights the importance of re-biopsy to identify pathologically SCLC transformation after resistance to ALK-TKI therapy. It also suggests that the treatment of atezolizumab in combination with etoposide and carboplatin may be effective for this rare phenotype. This report provides valuable insights into the genotypic and histological evolution of NSCLC to SCLC, particularly in ALK-rearranged adenocarcinomas, and underscores the need for further research and monitoring of patients in this rare condition.

Asset Subtitle

Guohao Xia

Meta Tag

Speaker Guohao Xia

Topic Small Cell Lung Cancer and Neuro-endocrine Tumours - Informing ES-SCLC

Keywords

ALK-rearranged adenocarcinoma

small-cell transformation

alectinib

EGFR

SCLC

brain metastases

EML4-ALK rearrangement

atezolizumab

etoposide

carboplatin