Targeted Therapy in a Young Adult With a Novel Epithelioid Tumor Driven by a PRRC2B-ALK Fusion

Authors:
Ajay GuptaDepartment of Pediatric Oncology, Roswell Park Comprehensive Cancer Institute, and
Department of Pediatrics, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York;

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Huifei LiuDepartment of Pathology and Laboratory Medicine, and

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Kathleen M. SchiefferThe Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio;

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Selene C. KooDepartment of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee;

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Catherine E. CottrellThe Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio;
Department of Pediatrics, and
Department of Pathology, The Ohio State University, Columbus, Ohio;

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Elaine R. MardisThe Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio;
Department of Pediatrics, and
Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio; and

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Ryan D. RobertsDepartment of Hematology/Oncology/BMT, Division of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio.

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Nicholas D. YeagerDepartment of Hematology/Oncology/BMT, Division of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio.

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This case report describes an 18-year-old woman with an unusual epithelioid tumor of the omentum with a novel PRRC2B-ALK fusion. Although the atypical pathologic features raised significant diagnostic challenges, expression of CD30 on tumor cells and detection of an ALK rearrangement provided critical information for selecting targeted therapy in a patient not suitable for surgical resection. Despite an initially promising therapeutic response, the patient died. The efficacy of treatment was confirmed by the lack of viable tumor cells at autopsy. This case highlights the role of timely targeted therapy in patients with rare tumors and novel actionable molecular targets.

Submitted March 15, 2021; final revision received May 3, 2021; accepted for publication May 3, 2021.

Author contributions: Data analysis and interpretation: Schieffer, Koo, Cottrell, Mardis. Manuscript writing – original draft: Gupta. Manuscript writing – review and editing: Gupta, Liu, Schieffer, Koo, Cottrell, Roberts, Yeager.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This research was supported by the Diagnostic Immunology Laboratory, Nationwide Children’s Hospital. Sequencing, data production, and analysis were supported by funding from Nationwide Foundation Pediatric Innovation Fund.

Correspondence: Ajay Gupta, MD, MS, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263. Email: ajay.gupta@roswellpark.org

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  • 1.

    Tsurubuchi T, Nakano Y, Hirato J, et al. Subependymal giant cell astrocytoma harboring a PRRC2B-ALK fusion: a case report. Pediatr Blood Cancer 2019;66:e27995.

  • 2.

    Theilen TM, Soerensen J, Bochennek K, et al. Crizotinib in ALK+ inflammatory myofibroblastic tumors—current experience and future perspectives. Pediatr Blood Cancer 2018;65:e26920.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Fordham AM, Blackburn J, Heyer EE, et al. Targeting CD30 as a novel treatment strategy in RANBP2-ALK-rearranged inflammatory myofibroblastic tumor [abstract]. Cancer Res 2019;79(13 Suppl):Abstract 4824.

    • Search Google Scholar
    • Export Citation
  • 4.

    Fordham AM, Xie J, Gifford AJ, et al. CD30 and ALK combination therapy has high therapeutic potency in RANBP2-ALK-rearranged epithelioid inflammatory myofibroblastic sarcoma. Br J Cancer 2020;123:11011113.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Straus DJ, Długosz-Danecka M, Alekseev S, et al. Brentuximab vedotin with chemotherapy for stage III/IV classical Hodgkin lymphoma: 3-year update of the ECHELON-1 study. Blood 2020;135:735742.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Fang H, Langstraat CL, Visscher DW, et al. Epithelioid inflammatory myofibroblastic sarcoma of the ovary with RANB2-ALK fusion: report of a case. Int J Gynecol Pathol 2018;37:468472.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Liu Q, Kan Y, Zhao Y, et al. Epithelioid inflammatory myofibroblastic sarcoma treated with ALK inhibitor: a case report and review of literature. Int J Clin Exp Pathol 2015;8:1532815332.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Connors JM, Ansell SM, Fanale M, et al. Five-year follow-up of brentuximab vedotin combined with ABVD or AVD for advanced-stage classical Hodgkin lymphoma. Blood 2017;130:13751377.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Lowe EJ, Reilly AF, Lim MS, et al. Brentuximab vedotin in combination with chemotherapy for pediatric patients with ALK+ALCL: results of COG Trial ANHL12P1. Blood 2021;137:35953603.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Foyil KV, Bartlett NL. Brentuximab vedotin and crizotinib in anaplastic large-cell lymphoma. Cancer J 2012;18:450456.

  • 11.

    Butrynski JE, D’Adamo DR, Hornick JL, et al. Crizotinib in ALK-rearranged inflammatory myofibroblastic tumor. N Engl J Med 2010;363:17271733.

  • 12.

    Kimbara S, Takeda K, Fukushima H, et al. A case report of epithelioid inflammatory myofibroblastic sarcoma with RANBP2-ALK fusion gene treated with the ALK inhibitor, crizotinib. Jpn J Clin Oncol 2014;44:868871.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Xu X, Li H, Peng K, et al. ALK-G1269A mutation in epithelioid inflammatory myofibroblastic sarcoma after progression on crizotinib: a case report. Oncol Lett 2019;17:23702376.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Stranzenbach R, Dippel E, Schlaak M, et al. Brentuximab vedotin in CD30+ cutaneous lymphoma: how do we treat, how shall we treat? A review of the literature. Br J Dermatol 2017;177:15031509.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Gotlib J, Baird JH, George TI, et al. A phase 2 study of brentuximab vedotin in patients with CD30-positive advanced systemic mastocytosis. Blood Adv 2019;3:22642271.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Borate U, Mehta A, Reddy V, et al. Treatment of CD30-positive systemic mastocytosis with brentuximab vedotin. Leuk Res 2016;44:2531.

  • 17.

    Albany C, Einhorn L, Garbo L, et al. Treatment of CD30-expressing germ cell tumors and sex cord stromal tumors with brentuximab vedotin: identification and report of seven cases. Oncologist 2018;23:316323.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Michallet AS, Guillermin Y, Deau B, et al. Sequential combination of gemcitabine, vinorelbine, pegylated liposomal doxorubicin and brentuximab as a bridge regimen to transplant in relapsed or refractory Hodgkin lymphoma. Haematologica 2015;100:e269e271.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Shaw AT, Gandhi L, Gadgeel S, et al. Alectinib in ALK-positive, crizotinib-resistant, non-small-cell lung cancer: a single-group, multicentre, phase 2 trial. Lancet Oncol 2016;17:234242.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Shash H, Stefanovici C, Phillips S, et al. Aggressive metastatic inflammatory myofibroblastic tumor after allogeneic stem cell transplant with fatal pulmonary toxicity from crizotinib. J Pediatr Hematol Oncol 2016;38:642645.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Pellegrino B, Facchinetti F, Bordi P, et al. Lung toxicity in non-small-cell lung cancer patients exposed to ALK inhibitors: report of a peculiar case and systematic review of the literature. Clin Lung Cancer 2018;19:e151e161.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Nitawaki T, Sakata Y, Kawamura K, et al. Case report: continued treatment with alectinib is possible for patients with lung adenocarcinoma with drug-induced interstitial lung disease. BMC Pulm Med 2017;17:173.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Hou H, Sun D, Liu K, et al. The safety and serious adverse events of approved ALK inhibitors in malignancies: a meta-analysis. Cancer Manag Res 2019;11:41094118.

  • 24.

    Faulk KE, Sopfe JM, Campbell K, et al. Pulmonary toxicity in paediatric patients with relapsed or refractory Hodgkin lymphoma receiving brentuximab vedotin. Br J Haematol 2018;183:251256.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Sabet Y, Ramirez S, Rosell Cespedes E, et al. Severe acute pulmonary toxicity associated with brentuximab in a patient with refractory Hodgkin’s lymphoma. Case Rep Pulmonol 2016;2016:2359437.

    • Search Google Scholar
    • Export Citation
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