Genomic Heterogeneity of ALK Fusion Breakpoints in Non-Small-Cell Lung
Modern Pathology (2018) 31, 791–808 © 2018 USCAP, Inc All rights reserved 0893-3952/18 $32.00 791 Genomic heterogeneity of ALK fusion breakpoints in non-small-cell lung cancer Jason N Rosenbaum1, Ryan Bloom2, Jason T Forys3, Jeff Hiken3, Jon R Armstrong3, Julie Branson4, Samantha McNulty4, Priya D Velu1, Kymberlie Pepin5, Haley Abel6, Catherine E Cottrell7, John D Pfeifer4, Shashikant Kulkarni8, Ramaswamy Govindan5, Eric Q Konnick9, Christina M Lockwood9 and Eric J Duncavage4 1Department of Pathology and Laboratory Medicine, University of Pennsylvania, The University of Pennsylvania Center for Personalized Diagnostics, Philadelphia, PA, USA; 2Unum Therapeutics, Cambridge, MA, USA; 3Cofactor Genomics, St Louis, MO, USA; 4Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St Louis, MO, USA; 5Department of Internal Medicine, Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA; 6McDonnell Genome Institute, Washington University School of Medicine, St Louis, MO, USA; 7Nationwide Children’s Hospital, Institute for Genomic Medicine, Columbus, OH, USA; 8Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA and 9Department of Laboratory Medicine, University of Washington, Seattle, WA, USA In lung adenocarcinoma, canonical EML4-ALK inversion results in a fusion protein with a constitutively active ALK kinase domain. Evidence of ALK rearrangement occurs in a minority (2–7%) of lung adenocarcinoma, and only ~ 60% of these patients will respond to targeted ALK inhibition by drugs such as crizotinib and ceritinib. Clinically, targeted anti-ALK therapy is often initiated based on evidence of an ALK genomic rearrangement detected by fluorescence in situ hybridization (FISH) of interphase cells in formalin-fixed, paraffin-embedded tissue sections.
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