Searching On:

Disease:

Gene:

Lung Cancer, ALK, Gene Translocation

View:
Expand Collapse Lung Cancer  - General Description This year about 226,000 people in the U.S. will be told by a doctor that they have lung cancer. However, about 390,000 Americans remain alive today after having been diagnosed with this malignancy. Lung cancer includes tumors that begin in tissues lining air passages inside the lungs and bronchi. The bronchi are the 2 branches of the windpipe (trachea) that lead to the lungs. Based on how the cells look under a microscope, lung cancers are divided into 2 main types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC accounts for 85% of these cases.

The main subtypes of NSCLC are squamous cell carcinoma (cancer beginning in thin, flat scaly-looking cells), adenocarcinoma (cancer beginning in cells that make mucus and other substances) and large cell carcinoma (cancer beginning in several types of large cells). The 2 main types of SCLC are small cell carcinoma (oat cell cancer) and combined small cell carcinoma.

Lung cancer (and other tumors) can spread (metastasize) from the place where it started (the primary tumor) in 3 ways. First, it can invade the normal tissue surrounding it. Second, cancer cells can enter the lymph system and travel through lymph vessels to distant parts of the body. Third, the cancer cells can get into the bloodstream and go to other places in the body. In these distant places, the cancer cells cause secondary tumors to grow. The main sites to which lung cancer spreads are the adrenal gland, liver and lungs.

To find out whether the cancer has entered the lymph system, a surgeon removes all or part of a node near the primary tumor and a pathologist looks at it through a microscope to see if cancer cells are present. Several kinds of imaging also can be performed to determine if the cancer has spread. These include MRI, bone scans and endoscopic ultrasound (EUS).

The FDA has approved several targeted therapies to treat patients with NSCLC. These include bevacizumab (Avastin), cetuximab (Erbitux), erlotinib (Tarceva), gefitnib (Iressa) and crizotinib (Xalkori). So far there are no FDA-approved targeted therapies for SCLC.

Despite significant improvements in the treatment of lung cancers, novel therapies and treatment strategies are needed.

Source: National Cancer Institute, 2012
Estimated new cases and deaths from lung cancer (non-small cell and small cell combined) in the United States in 2012:

New cases: 226,160
Deaths: 160,340

Lung cancer is the leading cause of cancer-related mortality in the United States. The 5-year relative survival rate from 1995 to 2001 for patients with lung cancer was 15.7%. The 5-year relative survival rate varies markedly depending on the stage at diagnosis, from 49% to 16% to 2% for patients with local, regional and distant stage disease, respectively.

NSCLC arises from the epithelial cells of the lung, from the central bronchi to the terminal alveoli. The histological type of NSCLC correlates with the site of origin, reflecting the variation in respiratory tract epithelium from the bronchi to the alveoli. Squamous cell carcinoma usually starts near a central bronchus while adenocarcinoma usually originates in peripheral lung tissue.

Tobacco smoking is the strongest risk factor for developing lung cancer, though it should be noted that the majority of patients diagnosed with lung cancer quit smoking years prior to diagnosis or were never-smokers (up to 15% of cases).

The identification of driver oncogene mutations in lung cancer has led to the development of targeted therapy that has vastly broadened treatment options and improved outcomes for subsets of patients with metastatic disease. It is now common practice to determine the genotype of a NSCLC patient early in the course of their diagnosis, to ensure that all possible treatment options are considered.

Source: National Cancer Institute, 2012
This year about 226,000 people in the U.S. will be told by a doctor that they have lung cancer. However, about 390,000 Americans remain alive today after having been diagnosed with this malignancy. Lung cancer includes tumors that begin in tissues lining air passages inside the lungs and bronchi. The bronchi are the 2 branches of the windpipe (trachea) that lead to the lungs. Based on how the cells look under a microscope, lung cancers are divided into 2 main types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC accounts for 85% of these cases.

The main subtypes of NSCLC are squamous cell carcinoma (cancer beginning in thin, flat scaly-looking cells), adenocarcinoma (cancer beginning in cells that make mucus and other substances) and large cell carcinoma (cancer beginning in several types of large cells). The 2 main types of SCLC are small cell carcinoma (oat cell cancer) and combined small cell carcinoma.

Lung cancer (and other tumors) can spread (metastasize) from the place where it started (the primary tumor) in 3 ways. First, it can invade the normal tissue surrounding it. Second, cancer cells can enter the lymph system and travel through lymph vessels to distant parts of the body. Third, the cancer cells can get into the bloodstream and go to other places in the body. In these distant places, the cancer cells cause secondary tumors to grow. The main sites to which lung cancer spreads are the adrenal gland, liver and lungs.

To find out whether the cancer has entered the lymph system, a surgeon removes all or part of a node near the primary tumor and a pathologist looks at it through a microscope to see if cancer cells are present. Several kinds of imaging also can be performed to determine if the cancer has spread. These include MRI, bone scans and endoscopic ultrasound (EUS).

The FDA has approved several targeted therapies to treat patients with NSCLC. These include bevacizumab (Avastin), cetuximab (Erbitux), erlotinib (Tarceva), gefitnib (Iressa) and crizotinib (Xalkori). So far there are no FDA-approved targeted therapies for SCLC.

Despite significant improvements in the treatment of lung cancers, novel therapies and treatment strategies are needed.

Source: National Cancer Institute, 2012
Estimated new cases and deaths from lung cancer (non-small cell and small cell combined) in the United States in 2012:

New cases: 226,160
Deaths: 160,340

Lung cancer is the leading cause of cancer-related mortality in the United States. The 5-year relative survival rate from 1995 to 2001 for patients with lung cancer was 15.7%. The 5-year relative survival rate varies markedly depending on the stage at diagnosis, from 49% to 16% to 2% for patients with local, regional and distant stage disease, respectively.

NSCLC arises from the epithelial cells of the lung, from the central bronchi to the terminal alveoli. The histological type of NSCLC correlates with the site of origin, reflecting the variation in respiratory tract epithelium from the bronchi to the alveoli. Squamous cell carcinoma usually starts near a central bronchus while adenocarcinoma usually originates in peripheral lung tissue.

Tobacco smoking is the strongest risk factor for developing lung cancer, though it should be noted that the majority of patients diagnosed with lung cancer quit smoking years prior to diagnosis or were never-smokers (up to 15% of cases).

The identification of driver oncogene mutations in lung cancer has led to the development of targeted therapy that has vastly broadened treatment options and improved outcomes for subsets of patients with metastatic disease. It is now common practice to determine the genotype of a NSCLC patient early in the course of their diagnosis, to ensure that all possible treatment options are considered.

Source: National Cancer Institute, 2012
Expand Collapse ALK  - General Description
CLICK IMAGE FOR MORE INFORMATION
ALK is a gene that provides the code for making a protein called anaplastic lymphoma kinase. This protein belongs to a family of proteins on the cell surface known as receptor tyrosine kinases (RTKs). RTKs are the first link in a chain that sends signals from the outside of a cell to the parts inside the cell that control different cellular processes, such as cell growth, cell division and cell differentiation. Anaplastic lymphoma kinase is believed to play a key role in brain development and helps regulate the proliferation of nerve cells during early stages of development. In cancer, either due to mutation or rearrangements in the ALK gene, its activity is continuously switched on, which in turn drives the cancer process.

At least 16 mutations in the ALK gene have been found in some patients with neuroblastoma, a cancer that develops in the immature nerve cells (neuroblasts) during childhood. In most cases, each mutation alters the structure of the ALK protein in different ways. These mutations result in the signaling pathway being switched on, increasing the proliferation of immature nerve cells and leading to neuroblastoma. Some of these mutations are called somatic because they are acquired during the course of a person's life and are found only in cells that become cancerous (not inherited from a parent). In some people with neuroblastoma, extra copies (gene amplification) of ALK cause too much protein to be made.

Rearrangements in the ALK gene also serve as an important driver of tumor growth. These rearrangements result in the production of a recombinant protein that is comprised of the front end of one protein fused together with the tyrosine kinase domain of ALK. The fusion partner can be any one of a number of genes, depending on the malignancy. For instance, in approximately 70 to 80% of ALK-positive anaplastic large cell lymphomas (ALCL), ALK is paired with the Nucleophosmin (NPM) gene. In lung cancer, ALK's translocation partner is primarily the EML4 gene. ALK rearrangements have also been described in other tumors including inflammatory myofibroblastic tumors, neural tumors, rhabdomyosarcomas and in some subtypes of breast cancer. Another type of rearrangement, an inversion, is found in a few people with non-small cell lung cancer (NSCLC), the most common type of lung cancer.

Source: Genetics Home Reference
ALK is a gene that provides the code for making a protein called anaplastic lymphoma kinase. This protein belongs to a family of proteins on the cell surface known as receptor tyrosine kinases (RTKs). RTKs are the first link in a chain that sends signals from the outside of a cell to the parts inside the cell that control different cellular processes, such as cell growth, cell division and cell differentiation. Anaplastic lymphoma kinase is believed to play a key role in brain development and helps regulate the proliferation of nerve cells during early stages of development. In cancer, either due to mutation or rearrangements in the ALK gene, its activity is continuously switched on, which in turn drives the cancer process.

At least 16 mutations in the ALK gene have been found in some patients with neuroblastoma, a cancer that develops in the immature nerve cells (neuroblasts) during childhood. In most cases, each mutation alters the structure of the ALK protein in different ways. These mutations result in the signaling pathway being switched on, increasing the proliferation of immature nerve cells and leading to neuroblastoma. Some of these mutations are inherited and some are called somatic because they are acquired during the course of a person's life and are found only in cells that become cancerous (not inherited from a parent). In some people with neuroblastoma, extra copies (gene amplification) of ALK cause too much protein to be made.

Rearrangements in the ALK gene also serve as an important driver of tumor growth. These rearrangements result in the production of a recombinant protein that is comprised of the front end of one protein fused together with the tyrosine kinase domain of ALK. The fusion partner can be any one of a number of genes, depending on the malignancy. For instance, in approximately 70 to 80% of ALK-positive anaplastic large cell lymphomas (ALCL), ALK is paired with the Nucleophosmin (NPM) gene. In lung cancer, ALK's translocation partner is primarily the EML4 gene. ALK rearrangements have also been described in other tumors including inflammatory myofibroblastic tumors, neural tumors, rhabdomyosarcomas and in some subtypes of breast cancer. Another type of rearrangement, an inversion, is found in a few people with non-small cell lung cancer (NSCLC), the most common type of lung cancer.

Source: Genetics Home Reference
Expand Collapse Gene Translocation  in ALK

Rearrangement involving the ALK gene is present in 3-5% of lung adenocarcinomas. ALK fusions are are not found together with EGFR mutations and are seen more frequently in young non-smoker patients. In the absence of ALK-targeted therapy, the prognosis of patients with ALK rearrangements is not different from the overall lung cancer population. Whether ALK-fusion positive lung cancer is more sensitive to specific cytotoxic chemotherapies than an unselected lung cohort is still a topic for investigation.

Deregulated ALK activity has strong oncogenic effects. For instance, tumors with ALK rearrangement have been shown to respond dramatically to ALK kinase inhibitors, such as the FDA-approved agent crizotinib. Response rates in the range of 60% and improved survival endpoints have been demonstrated in multiple trials. Novel targeted therapies against the ALK kinase are currently under investigation. The agent LKD378, also called ceritinib, was recently granted accelerated approval by the US Food and Drug Administration (FDA) for the treatment of patients wtih ALK-positive, metastatic non-small cell lung cancer (NSCLC) who previousy progressed during treatment with (or who were intolerant to) crizotinib. Ceritinib is a highly selective inhibitor of ALK, and the pivotal clinical trials that led to the approval of ceritinib (as well as those for crizotinib) were conducted at MGH (see refs below)

In preclinical and early clinical trials, chaperone (HSP90) inhibitors have also shown potential activity in ALK fusion-positive lung cancer, both in crizotinib-sensitive and crizotinib-resistant tumors. Clinical trials of HSP90 inhibitors and HSP90 inhibotors in combination with other targeted therapies are underway.

Rearrangement involving the ALK gene is present in 3-5% of lung adenocarcinomas. ALK fusions are are not found together with EGFR mutations and are seen more frequently in young non-smoker patients. In the absence of ALK-targeted therapy, the prognosis of patients with ALK rearrangements is not different from the overall lung cancer population. Whether ALK-fusion positive lung cancer is more sensitive to specific cytotoxic chemotherapies than an unselected lung cohort is still a topic for investigation.

Deregulated ALK activity has strong oncogenic effects. For instance, tumors with ALK rearrangement have been shown to respond dramatically to ALK kinase inhibitors, such as the FDA-approved agent crizotinib. Response rates in the range of 60% and improved survival endpoints have been demonstrated in multiple trials. Novel targeted therapies against the ALK kinase are currently under investigation. The agent LKD378, also called ceritinib, was recently granted accelerated approval by the US Food and Drug Administration (FDA) for the treatment of patients wtih ALK-positive, metastatic non-small cell lung cancer (NSCLC) who previousy progressed during treatment with (or who were intolerant to) crizotinib. Ceritinib is a highly selective inhibitor of ALK, and the pivotal clinical trials that led to the approval of ceritinib (as well as those for crizotinib) were conducted at MGH (see refs below)

In preclinical and early clinical trials, chaperone (HSP90) inhibitors have also shown potential activity in ALK fusion-positive lung cancer, both in crizotinib-sensitive and crizotinib-resistant tumors. Clinical trials of HSP90 inhibitors and HSP90 inhibotors in combination with other targeted therapies are underway.

PubMed ID's
20979469, 22215748, 21933749
Our Lung Cancer Team

Share with your Physican

Print information for your Physician.

Print information

Your Matched Clinical Trials

Trial Matches: (D) - Disease, (G) - Gene, (M) - Mutation
Trial Status: Showing Results: 1-10 of 50 Per Page:
12345Next »
Protocol # Title Location Status Match
NCT00585195 A Study Of Oral PF-02341066, A c-Met/Hepatocyte Growth Factor Tyrosine Kinase Inhibitor, In Patients With Advanced Cancer A Study Of Oral PF-02341066, A c-Met/Hepatocyte Growth Factor Tyrosine Kinase Inhibitor, In Patients With Advanced Cancer MGH Open DGM
NCT01970865 A Study Of PF-06463922 An ALK/ROS1 Inhibitor In Patients With Advanced Non Small Cell Lung Cancer With Specific Molecular Alterations A Study Of PF-06463922 An ALK/ROS1 Inhibitor In Patients With Advanced Non Small Cell Lung Cancer With Specific Molecular Alterations MGH Open DGM
NCT02568267 Basket Study of Entrectinib (RXDX-101) for the Treatment of Patients With Solid Tumors Harboring NTRK 1/2/3 (Trk A/B/C), ROS1, or ALK Gene Rearrangements (Fusions) Basket Study of Entrectinib (RXDX-101) for the Treatment of Patients With Solid Tumors Harboring NTRK 1/2/3 (Trk A/B/C), ROS1, or ALK Gene Rearrangements (Fusions) MGH Open DGM
NCT02201992 Crizotinib in Treating Patients With Stage IB-IIIA Non-small Cell Lung Cancer That Has Been Removed by Surgery and ALK Fusion Mutations (An ALCHEMIST Treatment Trial) Crizotinib in Treating Patients With Stage IB-IIIA Non-small Cell Lung Cancer That Has Been Removed by Surgery and ALK Fusion Mutations (An ALCHEMIST Treatment Trial) MGH Open DGM
NCT02193282 Erlotinib Hydrochloride in Treating Patients With Stage IB-IIIA Non-small Cell Lung Cancer That Has Been Completely Removed by Surgery (An ALCHEMIST Treatment Trial) Erlotinib Hydrochloride in Treating Patients With Stage IB-IIIA Non-small Cell Lung Cancer That Has Been Completely Removed by Surgery (An ALCHEMIST Treatment Trial) MGH Open DGM
NCT02097810 Study of Oral RXDX-101 in Adult Patients With Locally Advanced or Metastatic Cancer Targeting NTRK1, NTRK2, NTRK3, ROS1, or ALK Molecular Alterations. Study of Oral RXDX-101 in Adult Patients With Locally Advanced or Metastatic Cancer Targeting NTRK1, NTRK2, NTRK3, ROS1, or ALK Molecular Alterations. MGH Open DGM
NCT02927340 A Study of Lorlatinib in Advanced ALK and ROS1 Rearranged Lung Cancer With CNS Metastasis in the Absence of Measurable Extracranial Lesions A Study of Lorlatinib in Advanced ALK and ROS1 Rearranged Lung Cancer With CNS Metastasis in the Absence of Measurable Extracranial Lesions MGH Open DG
NCT02584634 Study to Evaluate Safety, Efficacy, Pharmacokinetics And Pharmacodynamics Of Avelumab In Combination With Either Crizotinib Or PF-06463922 In Patients With NSCLC. (Javelin Lung 101) Study to Evaluate Safety, Efficacy, Pharmacokinetics And Pharmacodynamics Of Avelumab In Combination With Either Crizotinib Or PF-06463922 In Patients With NSCLC. (Javelin Lung 101) MGH Open DG
NCT02052778 A Dose Finding Study Followed by a Safety and Efficacy Study in Patients With Advanced Solid Tumors or Multiple Myeloma With FGF/FGFR-Related Abnormalities A Dose Finding Study Followed by a Safety and Efficacy Study in Patients With Advanced Solid Tumors or Multiple Myeloma With FGF/FGFR-Related Abnormalities MGH Open D
NCT02637531 A Dose-Escalation Study to Evaluate the Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of IPI-549 A Dose-Escalation Study to Evaluate the Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of IPI-549 MGH Open D
Trial Status: Showing Results: 1-10 of 50 Per Page:
12345Next »
Our Lung Cancer Team

Share with your Physican

Print information for your Physician.

Print information