Ee Jie Yeo1, Liuh Ling Goh2 and Heong Valerie1*
1Department of Medical Oncology, Tan Tock Seng Hospital, Singapore
2Molecular Diagnostic Laboratory, Tan Tock Seng Hospital, Singapore
Background: In the age of precision oncology, molecular profiling has become increasingly available, which provides the potential to guide treatment options especially for patients where the site of origin is difficult to determine. Here, we present a case of a patient with EML4-ALK rearrangement in a gastric cancer, where molecular profiling helped guide therapeutic options.
Case Report: Mr. C is a 54-year-old, Asian, male, non-smoker, who initially presented with hematemesis, melena and gradual reduction of exercise tolerance. Staging scans revealed lesions in bladder, bone and lymphagitis. A transurethral resection of bladder tumor was done that revealed signet ring carcinoma. Subsequent oesophageal-gastro-duodenoscopy biopsied a gastric ulcer with similar morphology. After failing first line treatment of platinum-based chemotherapy, molecular profiling was performed which showed EML4-ALK fusion and after discussion with the patient, Alectinib was initiated. Patient responded well to Alectinib, with improvements both clinically and radiologically.
Conclusion: The case study highlights the utility of molecular profiling in clinical practice to help guide the use of targeted treatment. This case was complicated by his unusual presentation and was initially treated with standard of care chemotherapy. With next generation sequencing tools available at our centre, we were able to provide treatment based on presumed oncogenic drivers which proved beneficial in his case. However, this approach would need to be validated in larger tumour-agnostics’ basket studies based on molecular markers of interest.
Yeo EJ, Goh LL, Valerie H. An Unusual Presentation of Metastatic Gastric Cancer with EML4-ALK Rearrangement Treated with Alectinib. Clin Oncol. 2021;6:1859..