To the best of our knowledge, this is the first case report to discuss the successful management of ALK-rearranged lung SqCC with alectinib.
Our diagnosis of SqCC was confirmed by p40 immunostaining, which is useful and highly specific for the diagnosis of SqCC [
5,
6]. Additionally, in our case, the results of the
ALK detection test were concordant between IHC staining and FISH. Yamamoto et al. [
7] reported a similar case, which was diagnosed with
ALK-rearranged lung SqCC. The diagnosis was confirmed by IHC staining, which was positive for p40, but negative for thyroid transcription factor-1. The pathological specimen of their case [
7] was also obtained from the primary lesion by bronchoscopic biopsy and no adenocarcinoma component was detected in the biopsy specimen. The case reported by Yamamoto et al. [
7] was positive on FISH with a rearrangement-positive cell rate of just 20.0%, but negative on IHC staining. Ilie et al. [
8] reported that cases with discordant
ALK detection test results (i.e., FISH positive, but IHC staining negative) had lower rearrangement-positive cell rates of 15.0–20.0% and exhibited a tendency towards a lower response to crizotinib. However, since the case described by Yamamoto et al. [
7] was treated with radiotherapy without chemotherapy, it remains unclear whether the patient exhibited a marked response to ALK targeted therapies. As shown in Table
1, only a few cases of
ALK-rearranged lung SqCC responding to crizotinib have been reported to date [
9‐
12]. Alectinib is a new drug that is expected to be safer and more effective than crizotinib as a first-line chemotherapy treatment for patients with
ALK-rearranged lung adenocarcinoma [
13]. Recently, Tamiya et al. [
14] reported a case of
ALK-rearranged lung SqCC that was treated with alectinib, although no response was observed. In our case, the patient with
ALK-rearranged lung SqCC exhibited an antitumor response to alectinib. Further case reports are needed to confirm the efficacy of ALK targeted therapies for the treatment of
ALK-rearranged lung SqCC patients.
Table 1
Literature review of all clinical cases to date
| 55 | F | Biopsy of the cervical lymph node | IHC, FISH | Non-smoker | PDC | Crizotinib | PR |
| 36 | M | Bronchial biopsy of the primary lesion | IHC, FISH, RT-PCR | Non-smoker | None | Crizotinib | PR |
| 55 | F | Bronchial biopsy of the primary lesion | IHC | Non-smoker | PDC | Crizotinib | PR |
| 58 | F | Bronchial biopsy | IHC, FISH | Non-smoker | PDC | Crizotinib | PR |
| 78 | M | Primary lesion | IHC, FISH | 49 | None | Alectinib | PD |
This case | 52 | F | Bronchial biopsy of the mediastinal lymph node | IHC, FISH | Non-smoker | PDC | Alectinib | PR |
There are some limitations to our case report. Our histological specimen was small and was obtained from a mediastinal lymph node. For this reason, there was the potential for an adenocarcinoma component to be contained in other regions or for there to be discrepancies between the primary lesion and metastatic lesions due to the heterogeneity and distribution of the tumor. In contrast, Hou et al. [
15] reported a high concordance rate of
ALK rearrangement between primary tumors and paired metastatic lymph nodes, which supports the findings of our case report.
In conclusion, molecular testing for driver mutations should be considered in young patients with a light or no smoking history, even if the histological findings correspond with SqCC. Alectinib represents a reasonable option in cases of ALK-rearranged lung SqCC.