A Case of Lung Adenocarcinoma Resistant to Crizotinib Harboring a Novel EML4-ALK Variant, Exon 6 of EML4 Fused to Exon 18 of ALK Satoshi Anai, MD, Masafumi.

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A Case of Lung Adenocarcinoma Resistant to Crizotinib Harboring a Novel EML4-ALK Variant, Exon 6 of EML4 Fused to Exon 18 of ALK Satoshi Anai, MD, Masafumi Takeshita, MD, PhD, Nobuhisa Ando, MD, Yuuki Ikematsu, MD, Shohei Mishima, MD, Koichi Ishida, MD, Kouji Inoue, MD Journal of Thoracic Oncology Volume 11, Issue 10, Pages e126-e128 (October 2016) DOI: 10.1016/j.jtho.2016.07.008 Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 1 (A) Chest radiography shows ground-glass shadow in the left lower lung field. (B and C) Radiography of chest (B) before and (C) 8 days after crizotinib treatment shows disease progression. (D) Computed tomography on admission showed a nodule in the left lower lobe and interstitial shadowing. (E) Computed tomography shows tumor enlargement and large pericardial effusion with tamponade. (F) A fusion variant of echinoderm microtubule-associated protein-like 4 gene (EML4) exon 6 with anaplastic lymphoma receptor tyrosine kinase gene (ALK) exon 18 was identified by reverse transcription polymerase chain reaction and sequencing assays. (G) Amino acid sequence of the EML4-ALK fusion protein (EML4 in blue and ALK in red). (H) EML4-ALK fusion protein of the presented case expressed a transmembrane domain (TMD), but variant 3a did not. CC, coiled coil domain; WD, WD repeat domain. Journal of Thoracic Oncology 2016 11, e126-e128DOI: (10.1016/j.jtho.2016.07.008) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions