Anaplastic Lymphoma Kinase (ALK) Positive Neuroendocrine Tumor of Lung With Favorable Response to Alectinib (ALK Inhibitor)

ABSTRACT

Anaplastic lymphoma kinase (ALK) genetic alterations are commonly associated with and screened for in non-small cell lung carcinoma. However, the incidence and significance of ALK mutations in neuroendocrine lung tumors are poorly defined. This is a case of a 45-year-old female who presented with confusion, fall, and weakness. Investigation showed primary lung mass, two intracranial lesions, and an adrenal lesion. She underwent craniotomy and resection of the dominant parietal lesion, and the pathology demonstrated high-grade neuroendocrine carcinoma (combined small cell and large cell neuroendocrine carcinoma). She received one cycle of chemotherapy with carboplatin and etoposide, which was later switched to alectinib monotherapy after next-generation sequencing revealed ALK-EML4 fusion. She has shown a favorable response to therapy with stable disease and survival of more than sixty months even though she had intermittent development of new intracranial lesions requiring radiation therapy. This case provides evidence for the presence of ALK genetic alterations in neuroendocrine lung tumors and a positive response to ALK inhibitors.