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Case Report

Successful Alectinib Treatment for Carcinoma of Unknown Primary with EML4-ALK Fusion Gene: A Case Report

1
Department of Medical Oncology, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-Ku, Nagoya 460-0001, Japan
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Department of Pathology, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-Ku, Nagoya 460-0001, Japan
3
Department of Clinical Genetics, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-Ku, Nagoya 460-0001, Japan
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2021, 28(3), 1938-1945; https://doi.org/10.3390/curroncol28030180
Received: 13 April 2021 / Revised: 15 May 2021 / Accepted: 18 May 2021 / Published: 21 May 2021
Gene alteration in anaplastic lymphoma kinase (ALK) is rare, and the efficacy of ALK inhibitors in the treatment of carcinoma of unknown primary (CUP) with ALK alteration remains unclear. The patient was a 56-year-old woman who presented with cervical lymph node swelling. Computed tomography revealed paraaortic, perigastric, and cervical lymph node swelling; ascites; a liver lesion; and a left adrenal mass. A cervical lymph node biopsy was performed, and pathological diagnosis of an undifferentiated malignant tumor was conducted. Finally, the patient was diagnosed with CUP and treated with chemotherapy. To evaluate actionable mutations, we performed a multigene analysis, using a next-generation sequencer (FoundationOne® CDx). It revealed that the tumor harbored an echinoderm microtubule-associated protein-like 4 (EML4) and ALK fusion gene. Additionally, immunohistochemistry confirmed ALK protein expression. Alectinib, a potent ALK inhibitor, was recommended for the patient at a molecular oncology conference at our institution. Accordingly, alectinib (600 mg/day) was administered, and the multiple lesions and symptoms rapidly diminished without apparent toxicity. The administration of alectinib continued for a period of 10 months without disease progression. Thus, ALK-tyrosine kinase inhibitors should be considered in patients with CUP harboring the EML4-ALK fusion gene. View Full-Text
Keywords: carcinoma of unknown primary; next-generation sequencing; EML4-ALK; alectinib carcinoma of unknown primary; next-generation sequencing; EML4-ALK; alectinib
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MDPI and ACS Style

Sugiyama, K.; Izumika, A.; Iwakoshi, A.; Nishibori, R.; Sato, M.; Shiraishi, K.; Hattori, H.; Nishimura, R.; Kitagawa, C. Successful Alectinib Treatment for Carcinoma of Unknown Primary with EML4-ALK Fusion Gene: A Case Report. Curr. Oncol. 2021, 28, 1938-1945. https://doi.org/10.3390/curroncol28030180

AMA Style

Sugiyama K, Izumika A, Iwakoshi A, Nishibori R, Sato M, Shiraishi K, Hattori H, Nishimura R, Kitagawa C. Successful Alectinib Treatment for Carcinoma of Unknown Primary with EML4-ALK Fusion Gene: A Case Report. Current Oncology. 2021; 28(3):1938-1945. https://doi.org/10.3390/curroncol28030180

Chicago/Turabian Style

Sugiyama, Keiji; Izumika, Ai; Iwakoshi, Akari; Nishibori, Riko; Sato, Mariko; Shiraishi, Kazuhiro; Hattori, Hiroyoshi; Nishimura, Rieko; Kitagawa, Chiyoe. 2021. "Successful Alectinib Treatment for Carcinoma of Unknown Primary with EML4-ALK Fusion Gene: A Case Report" Curr. Oncol. 28, no. 3: 1938-1945. https://doi.org/10.3390/curroncol28030180

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