恩沙替尼治疗EML4-ALK/TP53共突变肺鳞癌1例并文献复习

Lung Squamous Cell Carcinoma with EML4-ALK Fusion and TP53 Co-mutation Treated with Ensartinib:A Case Report and Literature Review

肺鳞癌约占非小细胞肺癌(non-small cell lung cancer,NSCLC)的30%,是第二常见的肺癌组织学类型。具有间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)融合突变的NSCLC仅占所有NSCLC病例的2%-5%,且几乎只存在于肺腺癌患者中。因此ALK检测在肺鳞癌患者中不常规进行,个别见于报道的ALK融合突变肺鳞癌患者的靶向治疗效果也不清楚。本例晚期肺鳞癌患者通过二代测序发现存在棘皮动物微管相关蛋白样4(echinoderm microtubule associated protein like 4,EML4)-ALK(V1)和TP53共突变,2020年12月3日开始口服恩沙替尼,疗效评价为部分缓解(partial response,PR),无进展生存期(progression-free survival,PFS)达19个月,疾病进展后改为洛拉替尼。其中一线恩沙替尼治疗创造了有文献报道以来ALK突变肺鳞癌患者靶向治疗最长的PFS。本文报道了1例接受恩沙替尼治疗的EML4-ALK和TP53共突变肺鳞癌患者,并回顾相关文献,对此类罕见患者的治疗进行了讨论。

Lung squamous cell carcinoma(LSCC)accounts for approximately 30%of non-small cell lung cancer(NSCLC)cases and is the second most common histological type of lung cancer.Anaplastic lymphoma kinase(ALK)-positive NSCLC accounts for only 2%-5%of all NSCLC cases,and is almost exclusively detected in patients with lung adenocarcinoma.Thus,ALK testing is not routinely performed in the LSCC population,and the efficacy of such treatment for ALK-rearranged LSCC remains unknown.Echinoderm microtubule associated protein like 4(EML4)-ALK(V1)and TP53 co-mutations were identified by next generation sequencing(NGS)in this patient with advanced LSCC.On December 3,2020,Ensatinib was taken orally and the efficacy was evaluated as partial response(PR).The progression-free survival(PFS)was 19 months.When the disease progressed,the medication was changed to Loratinib.To our knowledge,Enshatinib created the longest PFS of ALK-mutant LSCC patients treated with targeted therapy since literature review.Herein,we described one case treated by Enshatinib involving a patient with both EML4-ALK and TP53 positive LSCC,and the relevant literatures were reviewed for discussing the treatment of this rare disease.