AI Article Synopsis
- - A patient with ALK-rearranged lung cancer developed resistance to crizotinib due to a mutation (C1156Y) in the ALK kinase domain, and her tumor did not respond to a second-generation ALK inhibitor.
- - The tumor was successfully treated with the third-generation ALK inhibitor lorlatinib, but upon relapse, it revealed a new mutation (L1198F) that caused resistance to lorlatinib while paradoxically enhancing sensitivity to crizotinib.
- - After discovering these mutations, the patient was treated again with crizotinib, resulting in the resolution of cancer-related symptoms and liver failure.
Article Abstract
In a patient who had metastatic anaplastic lymphoma kinase (ALK)-rearranged lung cancer, resistance to crizotinib developed because of a mutation in the ALK kinase domain. This mutation is predicted to result in a substitution of cysteine by tyrosine at amino acid residue 1156 (C1156Y). Her tumor did not respond to a second-generation ALK inhibitor, but it did respond to lorlatinib (PF-06463922), a third-generation inhibitor. When her tumor relapsed, sequencing of the resistant tumor revealed an ALK L1198F mutation in addition to the C1156Y mutation. The L1198F substitution confers resistance to lorlatinib through steric interference with drug binding. However, L1198F paradoxically enhances binding to crizotinib, negating the effect of C1156Y and resensitizing resistant cancers to crizotinib. The patient received crizotinib again, and her cancer-related symptoms and liver failure resolved. (Funded by Pfizer and others; ClinicalTrials.gov number, NCT01970865.).
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773904 | PMC |
| http://dx.doi.org/10.1056/NEJMoa1508887 | DOI Listing |
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