Response to ALK-TKIs in a lung adenocarcinoma patient harboring dual DCTN1-ALK and ALK-CLIP4 rearrangements

Rearrangements involving anaplastic lymphoma kinase (ALK) gene have been reported in similar to 5% of non-small-cell lung cancer patients. These rearrangements are characterized by the identification of various rare fusion partners, with unknown clinical significance. Specifically, the concurrence of different ALK fusions within the same patient, as well as its impact on therapeutic response to ALK tyrosine kinase inhibitors (ALK-TKIs), are rarely reported. Here, we report a 46-year-old female who was diagnosed with lung adenocarcinoma and identified carrying concurrent DCTN1-ALK and ALK-CLIP4 rearrangements by next generation sequencing (NGS) (638-gene panel). This patient showed partial response to crizotinib with a progress-free survival of 12 months and was then administered alectinib. Our report highlighted the importance of NGS testing in identifying rare ALK rearrangements and provided a novel insight into understanding the efficacy of ALK-TKI in this subset of patients.