Correct!
3. PCR for EGFR mutations and fluorescence in situ hybridization (FISH) for anaplastic lymphoma kinase (ALK) translocation
According to guidelines from the National Comprehensive Cancer Network (NCCN), all patients with lung adenocarcinoma, large cell carcinoma, or non-small cell cancer not otherwise specified should undergo testing for EGFR mutation and ALK rearrangement (5). Patients who benefit most from EGFR-directed therapies are those with activating and sensitizing EGFR mutations (6). ALK rearrangements are less common than mutations in EGFR, but their detection changes treatment. Crizotinib, an ALK inhibitor, has been approved for patients whose tumors contain an ALK rearrangement (7).
The patient’s cells from the thoracentesis showed a wild type on EGFR analysis. Additional FISH analysis of the ALK gene locus was positive for rearrangement in 92% of 50 nucleoli. Therefore, the patient was started on crizotinib in July 2012. Follow up CT scan in October 2012 demonstrated an excellent clinical response (Figure 5).
Figure 5. Follow up chest CT scan in October 2012 showing shrinkage of the left pleural effusion.
This case demonstrates that current assessment and treatment of non small cell lung cancer requires adequate tissue for histology and molecular profiling of the tumor. As more mutations affecting therapeutic decisions are discovered, such as the ROS 1 mutation, cancer care moves closer to the era of true personalized medicine. (8).
References