My Lung Cancer Alteration of ALK Gene

Little did I know that we were all born with the ALK (anaplastic lymphoma kinase) gene, but mine had an alteration. At diagnosis, I underwent a needle biopsy to get detailed information on the abnormalities of my ALK gene. During that time, liquid biopsy or blood draw has just started to emerge.

Managing ALK-positive lung cancer

With the alteration of my ALK gene, my cancer care specialists put TKI (tyrosine kinase inhibitors) as my first line of treatment and no chemotherapy. My TKI medication has slowed down my lung tumor growth and break in my brain mets (metastasis) since January 2020.

On the other hand, they saw traces of PD-L1 (programmed death-Ligand 1). However, immunotherapy treatment is not beneficial yet when you have both.

FISH testing

My oncologists requested a FISH (fluorescence in situ hybridization) test on the tumor tissue sample. This test further assessed the presence of ALK gene rearrangement or break apart of my ALK gene.

Recently, ALK-positive oncogenes come from 3%-5% of lung cancer patients with adenocarcinoma component. Furthermore, FISH test results helped my cancer care team to decide about what treatment I needed and to check how well the treatment is working. My TKI has been working for me since January 2020.¹

IHC testing

In precision medicine, less challenging and cost-efficient testing can provide meaningful results. IHC (immunohistochemistry) was another test done for me to validate and do more checking on my lung cancer tumor sub-type or structure.

This kind of testing plays a crucial role in a more precise diagnosis and proper treatment plan. The results showed I have NSCLC (non-small cell lung cancer) adenocarcinoma with PD-L1 of greater than 50% and ALK-positive oncogene.²

Emerging liquid biopsy

The emerging liquid biopsy analyzes blood sample for the presence of circulating cancerous tumor cells or tumor DNA (deoxyribonucleic acid), types of advanced cancers, predict prognosis and aid in making treatment decisions. Besides, one of the advantages of liquid biopsy is that it is much less invasive and painful than a tissue biopsy. This test will be the future of biomarker testing and useful when progression occurs.³

Challenges in dual ALK gene alteration and PD-L1 expression

In recent statistics, about 50% of ALK-positive patients got a diagnosis before the age of fifty; mine was at fifty-five. There are patients under the age of thirty.⁴

Furthermore, findings show that most patients are never smokers or have a light smoking history. There is no thought the mutation to be hereditary nor have correlation with smoking, second-hand smoke, and air pollution.⁴

Personalized treatment strategies

Based on my FISH and IHC results, there are TKIs for my ALK-positive advanced NSCLC adenocarcinoma. However, with my brain Mets, a second-generation TKI was chosen as my first line of treatment to control my lung tumor growth and penetrate my brain mets. They found that immunotherapy with PD-L1 and ALK Positive oncogene does not work well.

It is expected millions of lung cancer cases and deaths each year will increase. Hoping for TKI clinical trials and research for better medicines.

This improves the quality of life, decreases toxicity, and increases the number of patients with oncogene who survive beyond five years.