1324 - Analysis of EML4-ALK positive non-small cell lung cancer with advanced stage

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Biomarkers
Non-Small-Cell Lung Cancer, Metastatic
Presenter Jangchul Park
Authors J. Park1, C. Kondo2, J. Shimizu3, Y. Horio2, K. Yoshida2, Y. Yatabe4, T. Mitsudomi5, T. Hida2
  • 1Thoracic Oncology, Aichi Cancer Center Hospital, 4648681 - Nagoya/JP
  • 2Department Of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya/JP
  • 3Thoracic Oncology, Aichi Cancer Center, 4648681 - Nagoya/JP
  • 4Department Of Pathology And Molecular Diagnostics, Aichi Cancer Center, 46488681 - Nagoya/JP
  • 5Department Of Thoracic Surgery, Kinki University Faculty of Medicine, 5898511 - Sayama/JP



The purpose of this study is to investigate the clinical characteristics and the efficacy of the cytotoxic chemotherapy in the first and second line setting in EML4-ALK positive NSCLC with advanced stage.


EML4-ALK fusion was screened with RT-PCR and immunohistochemistry. When positive results were obtained with either method, gene rearrangement of ALK was confirmed with fluorescent in-situ hybridization. Clinical features and the efficacy of chemotherapy were evaluated retrospectively.


We evaluated 20 EML4-ALK positive patients with advanced stage. Seventeen (85%) of 20 had stage IV disease. Nine cases were male, and 11 were female. The mean ages were 46.3 years (range26-79). Most of their CT findings demonstrated mass or nodule in primary sites, while 2 cases showed air-space consolidation. In patients with stage IV the most common sites of metastasis at the first onset were bone (47.0%), followed by pleura (35.2%), liver (29.4%), and lung (23.5%). In 13 cases of which were evaluable in the first line setting, 7 (53.8%) had a partial response (PR), 4 (30.8%) had stable disease (SD), and 2 (15.4%) had progressive disease (PD). Among 10 evaluable cases in the second line setting, 2 (20%) had a PR, 5 (50%) had SD, and 3 had PD (30%). Two patients who had a PR were both treated by oral ALK inhibitor (crizotinib). One case had no response to crizotinib. Within the 7 patients who were treated by cytotoxic agents, none had marked clinical response. Five patients (71.4%) had SD, 2 patients had PD (28.6%) on single cytotoxic drug.


Our study suggests that the EML4-ALK positive patients may show relatively favorable response to cytotoxic drug in the first line setting, but low response in the second line setting. These data could be helpful for further clinical trials including EML4-ALK patients.


T. Mitsudomi: Dr. Mitsudomi has received lecture fees from AstraZeneca and Chugai, and he is a member of advisory boards of Pfizer and Boehringer-Ingelheim.

All other authors have declared no conflicts of interest.