A Prompt Diagnosis of Ascites and Dramatic Effect of Alectinib for Advanced Lung Adenocarcinoma Harboring EML4-ALK Fusion: A Case Report

Takahiro Baba; Hirofumi Inoue; Hiromi Matsuoka; Mio Kyakuno; Yusuke Yoshinaga; Tetsuya Takeguchi; Miho Fujiwara; Kotaro Yamada; Eri Nakamura; Ayako Morita; Naofumi Hara; Kiichiro Ninomiya; Hisao Higo; Masanori Fujii; Eiki Ichihara; Kammei Rai; Kadoaki Ohashi; Katsuyuki Hotta; Masahiro Tabata; Yoshinobu Maeda; Yosuke Togashi; Go Makimoto

doi:10.2169/internalmedicine.5397-25

A Prompt Diagnosis of Ascites and Dramatic Effect of Alectinib for Advanced Lung Adenocarcinoma Harboring EML4-ALK Fusion: A Case Report

Takahiro Baba, Hirofumi Inoue, Hiromi Matsuoka, Mio Kyakuno, Yusuke Yoshinaga, Tetsuya Takeguchi, Miho Fujiwara, Kotaro Yamada, Eri Nakamura, Ayako Morita, Naofumi Hara, Kiichiro Ninomiya, Hisao Higo, Masanori Fujii, Eiki Ichihara, Kammei Rai, Kadoaki Ohashi, Katsuyuki Hotta, Masahiro Tabata, Yoshinobu Maeda, Yosuke Togashi, Go Makimoto

Author information

Takahiro Baba
Department of Respiratory Medicine, Okayama University Hospital, Japan
Hirofumi Inoue
Department of Medical Support, Okayama University Hospital, Japan
Hiromi Matsuoka
Department of Medical Support, Okayama University Hospital, Japan
Mio Kyakuno
Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Japan
Yusuke Yoshinaga
Department of Respiratory Medicine, Okayama University Hospital, Japan
Tetsuya Takeguchi
Department of Respiratory Medicine, Okayama University Hospital, Japan
Miho Fujiwara
Department of Respiratory Medicine, Okayama University Hospital, Japan
Kotaro Yamada
Department of Respiratory Medicine, Okayama University Hospital, Japan
Eri Nakamura
Department of Respiratory Medicine, Okayama University Hospital, Japan
Ayako Morita
Department of Respiratory Medicine, Okayama University Hospital, Japan
Naofumi Hara
Department of Respiratory Medicine, Okayama University Hospital, Japan
Kiichiro Ninomiya
Center for Comprehensive Genomic Medicine, Okayama University Hospital, Japan
Hisao Higo
Department of Respiratory Medicine, Okayama University Hospital, Japan
Masanori Fujii
Department of Geriatric Medicine, Okayama University Hospital, Japan
Eiki Ichihara
Center for Clinical Oncology, Okayama University Hospital, Japan
Kammei Rai
Center for Innovative Clinical Medicine, Okayama University Hospital, Japan
Kadoaki Ohashi
Department of Respiratory Medicine, Okayama University Hospital, Japan
Katsuyuki Hotta
Center for Innovative Clinical Medicine, Okayama University Hospital, Japan
Masahiro Tabata
Center for Clinical Oncology, Okayama University Hospital, Japan
Yoshinobu Maeda
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
Yosuke Togashi
Department of Respiratory Medicine, Okayama University Hospital, Japan
Department of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Go Makimoto
Department of Respiratory Medicine, Okayama University Hospital, Japan

Keywords: lung adenocarcinoma, EML4-ALK, AmoyDx^®, Pan Lung Cancer PCR Panel, alectinib

JOURNAL OPEN ACCESS Advance online publication

Article ID: 5397-25

DOI https://doi.org/10.2169/internalmedicine.5397-25

Details

Abstract

A 75-year-old never-smoker woman presented with dyspnea and loss of appetite. A mass was identified in the left upper lobe of the lung, and the patient was referred to our hospital. Despite the diagnosis of lung adenocarcinoma via bronchoscopy, ALK immunostaining was negative. Rapid weight gain and abdominal distension caused by ascites prompted fluid testing using the AmoyDx Pan Lung Cancer PCR Panel. EML4-ALK fusion was confirmed, and alectinib therapy was initiated immediately. The tumor size had decreased significantly, and the patient was discharged on day 34. This case highlights the necessity of multiplex genetic testing even when ALK immunostaining is negative.

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