ALK rearrangements are mutually exclusive with mutations in EGFR or KRAS: an analysis of 1683 patients with non-small cell lung cancer
A partir de données de génotypage portant sur 1 683 patients atteints d'un cancer du poumon non à petites cellules (NAPC), puis menée sur des échantillons tumoraux prélevés sur 34 patients atteints d'un cancer du poumon NAPC avec réarrangements du gène ALK et ayant développé une résistance au crizotinib, cette étude montre que, si une tumeur présente des réarrangements du gène ALK, les gènes EGFR et KRAS ne sont pas mutés, et réciproquement
Background: Anaplastic lymphoma kinase (ALK) gene rearrangements define a distinct molecular subset of non-small cell lung cancer (NSCLC). Recently, several case reports and small series have reported that ALK rearrangements can overlap with other oncogenic drivers in NSCLC in crizotinib-naïve and resistant cancers. Methods: We reviewed clinical genotyping data from 1683 NSCLC patients and investigated the prevalence of concomitant EGFR or KRAS mutations among patients with ALK-positive NSCLC. We also examined biopsy specimens from 34 patients with ALK-positive NSCLC after the development of resistance to crizotinib. Results: Screening identified 301 (17.8%) EGFR mutations, 465 (27.6%) KRAS mutations, and 75 (4.4%) ALK rearrangements. EGFR mutations and ALK rearrangements were mutually exclusive. Four patients with KRAS mutations were found to have abnormal ALK fluorescence in situ hybridization (FISH) patterns, most commonly involving isolated 5' green probes. Sufficient tissue was available for confirmatory ALK immunohistochemistry in 3 cases, all of which were negative for ALK expression. Among patients with ALK-positive NSCLC who acquired resistance to crizotinib, repeat biopsy specimens were ALK FISH positive in 29/29 (100%) cases. Secondary mutations in the ALK kinase domain and ALK gene amplification were observed in 7/34 (20.6%) and 3/29 (10.3%) cases, respectively. No EGFR or KRAS mutations were identified among any of the 25 crizotinib-resistant, ALK-positive patients with sufficient tissue for testing. Conclusions: Functional ALK rearrangements were mutually exclusive with EGFR and KRAS mutations in a large Western patient population. This lack of overlap was also observed in ALK-positive cancers with acquired resistance to crizotinib.