Experience with Erlotinib in Lung Adenocarcinoma Harboring a Coexisting KIF5B-RET Fusion Gene and EGFR Mutation: Report of a Rare Case Fumihiko Hirai,

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Experience with Erlotinib in Lung Adenocarcinoma Harboring a Coexisting KIF5B-RET Fusion Gene and EGFR Mutation: Report of a Rare Case Fumihiko Hirai, MD, Mitsuhiro Takenoyama, MD, Kenichi Taguchi, MD, Ryo Toyozawa, MD, Eiko Inamasu, MD, Gouji Toyokawa, MD, Tsukihisa Yoshida, MD, Yoshimasa Shiraishi, MD, Tomoyoshi Takenaka, MD, Masafumi Yamaguchi, MD, Chie Ushijima, MD, Takashi Seto, MD, Sadanori Takeo, MD, Yukito Ichinose, MD Journal of Thoracic Oncology Volume 9, Issue 5, Pages e37-e39 (May 2014) DOI: 10.1097/JTO.0000000000000097 Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Histology of (A) the primary tumor and (B) metastatic supraclavicular LN. (1) The adenocarcinoma component with a predominant papillary structure (hematoxylin and eosin, ×200). An immunohistochemical examination revealed that the primary lesion and metastatic lesion were both positive for (2) thyroid transcription factor 1 (TTF1)/Napsin A and (3) CK7 and negative for (4) monoclonal anti-anaplastic lymphoma kinase (ALK) antibodies (5A4, ×200). LN, lymph node. Journal of Thoracic Oncology 2014 9, e37-e39DOI: (10.1097/JTO.0000000000000097) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Results of fusion-specific reverse transcription polymerase chain reaction of the primary lesion and metastatic lymph node. KIF5B-RET fusion gene, predicted product size of 154 bp; (lane 1) no template control, (lane 2) primary lesion, (lane 3) metastatic LN, (lane 4) negative control, and (lane 5) positive control. Primers for detection of KIF5B (exon 15)-RET (exon 12) fusion genes: forward (KIF5B exon 15) 5′-CTTAAGGAAATGACCAACCACC-3′; and reverse (RET exon 12) 5′-TCCAAATTCGCCTTCTCCTAGAG-3′. Journal of Thoracic Oncology 2014 9, e37-e39DOI: (10.1097/JTO.0000000000000097) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Gene sequence analysis of (A) the primary tumor and (B) metastatic supraclavicular lymph node. A direct sequence analysis revealed a variant 1 mutation of the KIF5B-RET fusion gene in the metastatic lesion. Journal of Thoracic Oncology 2014 9, e37-e39DOI: (10.1097/JTO.0000000000000097) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions