World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website http://www.wjon.org

Case Report

Volume 9, Number 2, April 2018, pages 50-55


Synchronous Presence of EGFR, ALK Driver Mutations Along With PD L1 Overexpression in a Resected Early Stage Non-Small Cell Lung Cancer: A Case Report and Review of Literature

Tables

Table 1. Summary of Previously Reported Patient Characteristics and Treatment Outcomes of NSCLC With Concomitant EGFR Mutation and ALK Fusion [2, 6-19]
 
AuthorPatientsAgeSex/ethinicitySmoking statusEGFR mutationFirst lineBest responseSecond lineBest responseThird lineBest response
AC: adenocarcinoma; A: Asian; Beva: Bevacizumab; C: Caucasian; Carbo: carboplatin; Cis: cisplatin; CR: complete remission; Doc: docetaxel; Gem: gemcitabine; Heavy smoker: more than 1 pack a day; Light smoker: less than 1 pack a day; ND: not done; NR: not reported; Pts: patients; PD: progressive disease; PR: partial response; Pac: paclitaxel; Pem: pemetrexed; SC: squamous carcinoma; SD: stable disease; TKI: tyrosine kinase inhibitor.
Thumallapally et al [2]172M/CHeavyL861Q exon21CrizotinibNRND
Chiari et al [13]167F/CNeverL858R exon 21Carbo/PemSDGefitinib/erlotinib/afatinibPR/PDCrizotinibPR
Chen et al [11]156F/AHeavyDel exon 19Cis/GemToxicityErlotinibSDCrizotinibCR
Miyanaga et al [14]155F/ANeverDel exon 19Cis/PemSDGefitinib/erlotinibPDCrizotinibSD
SD
Tanaka et al [15]139M/ALightDel exon 19Cis/DocSDPEMPRErlotinibPD
Tiseo et al[9]148M/CNeverDel exon 19Cis/GemPRErlotinibPD
Popat et al [10]165F/CNeverDel exon 19Carbo/vinorelbinePRErlotinibCR
Santelmo et al [7]152F/ CHeavyDel exon 19GefitinibPRND
Zhao et al [16]148F/ANeverL858R exon 21ErlotinibSDCrizotinibSD
Rossing et al [17]161M/CNeverL858R exon 21Carboplatin/vinorelbine/BevaPRCrizotinibPRPEMPD
Lee et al [6]173M/AsianFormerDel exon 19GefitinibPDCrizotinibPR
Jurgens et al [18]169M/CLight smokerexon 21 L 861GefitinibPDCarbo/Pem/BevaPRPemPD
Sasaki et al [19]2NRAsianNRDel exon 19 (2)Erlotinib (2)PR (2)ND
Yang et al [8]11Median age 59Female (8)/male (3)/AsianNever (11)Del exon 19 (6)Gefitinib (3)PR (3)Crizotinib(2)PR(1), S D(1)
L858R exon 21 (4)Erlotinib (5)PR (4), PD (1)Crizotinib(1)PD(1)
Exon 20 (1)Afatinib (2)PR (1), SD (1)Crizotinib (1)PR(1)
Sweiss et al [12]337Male (2)/female (1)Never smoker (2)Exon 23 polymorphismCarbo/Beva/PacPRErlotinib/BevaPDCrizotinibSD
57Heavy smoker (1)Exon 19 Del (1)ErlotinibPRCrizotinibPDErlotinibPD
52L858R (1)CrizotinibPDCarbo/PemPD
Thumallapally et al (current patient)177M/CLightL858R exon21Cis/pemSDND

 

Table 2. Adjuvant Targeted Therapy in Resected NSCLC [25, 28-30]
 
PFS: progression-free survival; DFS: disease-free survival; OS: overall survival.
Zhong et al [25] (ADJUVANT trial)Phase IIIResected stage II-IIIA EGFR mutant NSCLCN = 222Gefitinib vs. cisplatin plus vinorelbineMedian PFS was 28.7 months with gefitinib and 18 months with cisplatin plus vinorelbine.
Kelly et al [28] (RADIANT trial)Phase IIIResected stage Ib-IIIA NSCLC. Tumors expressed EGFR protein by IHC or FISHN = 973Erlotinib vs. placeboMedian PFS was 50.7 months with erlotinib and 48.2 months with placebo.
Pennell et al [29] (SELECT trial)Single arm Phase IIResected stage IA-IIIA EGFR mutant NSCLCN = 100Erlotinib 150 mg/day for 2 years after adjuvant chemotherapyTwo-year DFS was 90%. Median time to recurrence after stopping erlotinib was 12 months.
Goss et al [30] (NCIC CTG BR19 trial)Phase IIIResected stage IB-IIIA NSCLCN = 503Gefitinb 250 mg daily or placebo after adjuvant chemotherapyMedian DFS and OS were similar in both the groups.
ALCHEMIST (NCT02193282)Randomized phase IIIResected stage IB-IIIA EGFR mutant NSCLCN = 450 estimationAdjuvant erlotinib vs. placeboCurrently ongoing
ADAURA (NCT02511106)Randomized phase IIIResected stage IB-IIIA EGFR mutant NSCLCN = 700 estimationAdjuvant AZD9291 vs. placeboCurrently ongoing

 

Table 3. Adjuvant Immunotherapy Trials in NSCLC [31, 32]
 
PEARLS trial [31] (NCT02504372)Randomized phase IIIResected stage IB-IIIA NSCLCN = 1,380Pembrolizumab 200 mg IV every 3 weeks for 1 year vs. placebo after standard adjuvant treatmentCurrently ongoing
ANVIL trial [32] NCT02595944Randomized phase IIIResected stage IB-IIIA NSCLCN = 714Nivolumab every 2 weeks for 1 year vs. observation after standard adjuvant treatmentCurrently ongoing
NCT02273375Randomized phase IIIResected stage IB-IIIA NSCLCN = 1,360MEDI4736 IV infusion for 12 months vs. placebo infusion after standard adjuvant treatmentCurrently ongoing
NCT02486718Randomized phase IIIResected stage IB-IIIA NSCLCN = 1,127Atezolizumab IV infusion Q3 weeks for 16 cycles vs. observation after standard platinum based chemotherapyCurrently ongoing