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Gene ALK
Variant F1174L
Impact List missense
Protein Effect gain of function
Gene Variant Descriptions ALK F1174L lies within the protein kinase domain of the Alk protein (UniProt.org). F1174L confers a gain of function to the Alk protein as indicated by transformation activity and increased cell proliferation in culture (PMID: 18923525, PMID: 29533785, PMID: 29907598), and has been demonstrated to occur as a secondary resistance mutation in the context of ALK fusions (PMID: 21030459, PMID: 31452835).
Associated Drug Resistance Y
Category Variants Paths

ALK mutant ALK act mut ALK F1174L

ALK mutant ALK F1174X ALK F1174L

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Transcript NM_004304.5
gDNA chr2:g.29220831A>G
cDNA c.3520T>C
Protein p.F1174L
Source Database RefSeq
Genome Build GRCh38/hg38
Transcript gDNA cDNA Protein Source Database Genome Build
NM_004304.4 chr2:g.29220831A>G c.3520T>C p.F1174L RefSeq GRCh38/hg38
NM_004304 chr2:g.29220831A>G c.3520T>C p.F1174L RefSeq GRCh38/hg38
NM_004304.5 chr2:g.29220831A>G c.3520T>C p.F1174L RefSeq GRCh38/hg38

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Molecular Profile Indication/Tumor Type Response Type Therapy Name Approval Status Evidence Type Efficacy Evidence References
ALK F1174L Advanced Solid Tumor sensitive Brigatinib Preclinical - Cell culture Actionable In a preclinical study, a transformed cell line expressing ALK F1174L was sensitive to Alunbrig (brigatinib) in culture, resulting in cell growth inhibition (PMID: 27049722). 27049722
ALK F1174L neuroblastoma conflicting Crizotinib Case Reports/Case Series Actionable In a Phase I/II trial (ADVL0912), Xalkori (crizotinib) treatment resulted in an objective response of 15% (3/20) in pediatric patients with relapsed/refractory neuroblastoma harboring ALK activating mutations or amplifications, although all 3 patients harboring ALK F1174L had disease progression after only 1 cycle of treatment (PMID: 33568345; NCT00939770). 33568345
ALK F1174L neuroblastoma conflicting Crizotinib Case Reports/Case Series Actionable In a Phase Ib trial (PROFILE 1013), Xalkori (crizotinib) therapy resulted in stable disease lasting 19 months in a patient with advanced neuroblastoma harboring ALK F1174L (PMID: 29352732; NCT00939770). 29352732
ALK F1174L neuroblastoma conflicting Crizotinib Preclinical - Pdx & cell culture Actionable In a preclinical study, Xalkori (crizotinib) did not inhibit growth of neuroblastoma cells over expressing ALK F1174L in culture, and only delayed tumor growth in patient-derived and cell line xenograft models harboring ALK F1174L (PMID: 26554404). 26554404
ALK F1174L neuroblastoma conflicting Crizotinib Preclinical - Cell culture Actionable In a preclinical study, Xalkori (crizotinib) treatment inhibited viability of neuroblastoma cell lines harboring ALK F1174L in culture (PMID: 38032104). 38032104
ALK F1174L neuroblastoma predicted - sensitive Lorlatinib Case Reports/Case Series Actionable In a clinical case study, Lorbrena (lorlatinib) treatment resulted in a complete response in 3 of 5 patients and a partial response in 1 of 5 patients with neuroblastoma harboring ALK F1174L (PMID: 37561984). 37561984
ALK F1174L neuroblastoma predicted - sensitive Lorlatinib Case Reports/Case Series Actionable In a clinical case study, Lorbrena (lorlatinib) treatment resulted in a complete response lasting 13 mo in a pediatric patient with metastatic, relapsed neuroblastoma harboring ALK F1174L and PIK3CA C692Ffs*8, who had previously progressed on combination therapy with Xalkori (crizotinib), Cytoxan (cyclophosphamide), and Topotecan (PMID: 34210658). 34210658
ALK F1174L neuroblastoma predicted - sensitive Lorlatinib Case Reports/Case Series Actionable In a clinical case study, Lorbrena (lorlatinib) treatment resulted in stable disease after 4 cycles in a pediatric patient with neuroblastoma harboring ALK F1174L (PMID: 36765519). 36765519
ALK F1174L neuroblastoma predicted - sensitive Lorlatinib Case Reports/Case Series Actionable In a Phase I trial, Lorbrena (lorlatinib) treatment resulted in a minor response with stable disease in a neuroblastoma patient harboring ALK F1174L (PMID: 37147298; NCT03107988). 37147298
ALK F1174L neuroblastoma predicted - sensitive Lorlatinib Preclinical - Cell line xenograft Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited downstream signaling, viability, and invasion in neuroblastoma cell lines harboring ALK F1174L in culture, and decreased tumor growth and increased survival in cell line xenograft models (PMID: 38032104). 38032104
ALK F1174L neuroblastoma predicted - sensitive Lorlatinib Preclinical - Pdx & cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited growth of neuroblastoma cells over expressing ALK F1174L in culture, and induced rapid and sustained complete tumor regression in both patient-derived and cell line xenograft models harboring ALK F1174L (PMID: 26554404). 26554404
ALK F1174L neuroblastoma predicted - sensitive Lorlatinib Preclinical Actionable In a preclinical study, Lorbrena (lorlatinib) treatment induced tumor regression in a transgenic mouse model of neuroblastoma harboring ALK F1174L (PMID: 27483357). 27483357
ALK F1174L neuroblastoma predicted - sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, neuroblastoma cells harboring ALK F1174L were resistant to Lorbrena (lorlatinib) in culture (PMID: 30322862). 30322862
ALK F1174L Advanced Solid Tumor sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited foci formation more efficiently than Xalkori (crizotinib) in transformed cells overexpressing ALK F1174L in culture (PMID: 26554404). 26554404
ALK F1174L Advanced Solid Tumor sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) treatment inhibited Alk phosphorylation and viability in transformed cells expressing ALK F1174L in culture (PMID: 27483357). 27483357
ALK F1174L neuroblastoma sensitive CEP-28122 Preclinical - Cell culture Actionable In a preclinical study, CEP-28122 inhibited growth of neuroblastoma cells harboring ALK F1174L in culture (PMID: 22203728). 22203728
ALK F1174L neuroblastoma sensitive AZD3463 Preclinical - Cell line xenograft Actionable In a preclinical study, AZD3463 inhibited growth of neuroblastoma cells harboring ALK F1174L in culture, resulted in near complete tumor regression in cell line xenograft models (PMID: 26786851). 26786851
ALK F1174L neuroblastoma conflicting Crizotinib + Cyclophosphamide + Topotecan Case Reports/Case Series Actionable In a clinical case study, combination treatment with Xalkori (crizotinib), Cytoxan (cyclophosphamide), and Topotecan resulted in a complete response after 2 cycles in a one pediatric patient, and a clinical response with stable disease lasting 7 months in another pediatric patient with relapsed neuroblastoma harboring ALK F1174L (PMID: 36765519). 36765519
ALK F1174L neuroblastoma conflicting Crizotinib + Cyclophosphamide + Topotecan Case Reports/Case Series Actionable In a clinical case study, combination treatment with Xalkori (crizotinib), Cytoxan (cyclophosphamide), and Topotecan resulted in progressive disease within 1 cycle of therapy in a pediatric patient with metastatic, relapsed neuroblastoma harboring ALK F1174L and PIK3CA C692Ffs*8 (PMID: 34210658). 34210658
ALK F1174L Advanced Solid Tumor predicted - sensitive TPX-0131 Preclinical - Biochemical Actionable In a preclinical study, TPX-0131 inhibited kinase activity of ALK F1174L in an in vitro assay (PMID: 34158340). 34158340
ALK F1174L neuroblastoma sensitive Vandetanib Preclinical Actionable In a preclinical study, Caprelsa (vandetanib) treatment resulted in decreased tumor weight in a Mycn-overexpressing neuroblastoma transgenic mouse model with ALK F1174L (corresponds to F1178L in mouse) and subsequent upregulation of Ret (PMID: 24811913). 24811913
ALK F1174L neuroblastoma predicted - sensitive Entrectinib Case Reports/Case Series Actionable In a Phase I/II trial, Rozlytrek (entrectinib) treatment resulted in a complete response in a patient with neuroblastoma harboring ALK F1174L (PMID: 35395680; NCT02650401). 35395680
ALK F1174L neuroblastoma sensitive TQ-B3139 Preclinical - Cell line xenograft Actionable In a preclinical study, TQ-B3139 (CT-711) inhibited proliferation of a neuroblastoma cell line harboring ALK F1174L in culture and inhibited tumor growth in a cell line xenograft model (PMID: 30210922). 30210922
ALK F1174L neuroblastoma sensitive Repotrectinib Preclinical - Cell culture Actionable In a preclinical study, Augtyro (repotrectinib) inhibited proliferation of a neuroblastoma cell line harboring ALK F1174L in culture (PMID: 31852910). 31852910
ALK F1174L Advanced Solid Tumor sensitive Repotrectinib Preclinical - Cell culture Actionable In a preclinical study, Augtyro (repotrectinib) decreased Alk phosphorylation and neurite outgrowth in cells expressing ALK F1174L in culture (PMID: 31852910). 31852910
ALK F1174L Advanced Solid Tumor predicted - sensitive Conteltinib Preclinical - Biochemical Actionable In a preclinical study, Conteltinib (CT-707) inhibited ALK F1174L activity in an in vitro assay (PMID: 36424628). 36424628
ALK F1174L neuroblastoma sensitive Cyclophosphamide + Doxorubicin + Lorlatinib + Vincristine Sulfate Preclinical Actionable In a preclinical study, the combination of Lorbrena (lorlatinib), Cytoxan (cyclophosphamide), Adriamycin (doxorubicin), and Oncovin (vincristine) resulted in an early tumor response, and improved survival in a genetically engineered mouse model of neuroblastoma harboring ALK F1174L (PMID: 36602782). 36602782
ALK F1174L neuroblastoma sensitive Ceritinib + Ribociclib Preclinical - Cell line xenograft Actionable In a preclinical study, the combination of Zykadia (ceritinib) and Kisqali (ribociclib) synergistically inhibited proliferation and Alk phosphorylation and induced cell cycle arrest in neuroblastoma cell line harboring ALK F1174L in culture, and induced complete tumor regression and increased event-free survival compared to either agent alone (P<0.0001) in a cell line xenograft model (PMID: 27986745). 27986745
ALK F1174L neuroblastoma sensitive 4SC-205 + Ceritinib Preclinical - Cell culture Actionable In a preclinical study, the combination of 4SC-205 and Zykadia (ceritinib) inhibited viability to a greater degree than either therapy alone in neuroblastoma cell lines harboring ALK F1174L (PMID: 34709738). 34709738
ALK F1174L neuroblastoma sensitive 4SC-205 + Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, the combination of 4SC-205 and Lorbrena (lorlatinib) inhibited viability to a greater degree than either therapy alone in neuroblastoma cell lines harboring ALK F1174L (PMID: 34709738). 34709738
ALK F1174L Advanced Solid Tumor sensitive CCC-003 Preclinical - Cell culture Actionable In a preclinical study, CCC-003 inhibited viability in transformed cells expressing ALK F1174L in culture (PMID: 34591871). 34591871
ALK F1174L neuroblastoma sensitive CCC-003 Preclinical - Cell line xenograft Actionable In a preclinical study, CCC-003 treatment resulted in decreased cell proliferation and induction of apoptosis in neuroblastoma cell lines harboring ALK F1174L in culture, and inhibited tumor growth in a cell line xenograft model (PMID: 34591871). 34591871
ALK F1174L neuroblastoma sensitive TNO155 Preclinical - Cell line xenograft Actionable In a preclinical study, TNO155 decreased viability and invasion of neuroblastoma cell lines harboring ALK F1174L in culture and decreased tumor growth and cell invasion and increased survival in cell line xenograft models (PMID: 38032104). 38032104
ALK F1174L neuroblastoma sensitive Ceritinib Preclinical - Cell line xenograft Actionable In a preclinical study, Zykadia (ceritinib) inhibited downstream signaling and viability in neuroblastoma cell lines harboring ALK F1174L in culture and reduced cell invasion in a cell line xenograft model (PMID: 38032104). 38032104
ALK F1174L neuroblastoma sensitive Ceritinib + TNO155 Preclinical - Cell line xenograft Actionable In a preclinical study, treatment with the combination of TNO155 and Zykadia (ceritinib) resulted in enhanced inhibition of downstream signaling and invasion and synergistically decreased viability of neuroblastoma cell lines harboring ALK F1174L in culture and led to significantly decreased tumor growth in a cell line xenograft model compared to either agent alone (PMID: 38032104). 38032104
ALK F1174L neuroblastoma sensitive Lorlatinib + TNO155 Preclinical - Cell line xenograft Actionable In a preclinical study, treatment with the combination of TNO155 and Lorbrena (lorlatinib) inhibited downstream signaling and invasion and synergistically decreased viability of neuroblastoma cell lines harboring ALK F1174L in culture, decreased growth and improved survival compared to either agent alone in cell line xenograft models, and treatment with TNO155 restored sensitivity to Lorbrena (lorlatinib) in Lorbrena (lorlatinib)-resistant cell lines and cell line xenograft models (PMID: 38032104). 38032104
ALK F1174L neuroblastoma sensitive Crizotinib + TNO155 Preclinical - Cell culture Actionable In a preclinical study, treatment with the combination of TNO155 and Xalkori (crizotinib) synergistically decreased viability of neuroblastoma cell lines harboring ALK F1174L in culture (PMID: 38032104). 38032104
ALK F1174L neuroblastoma sensitive Crizotinib + SHP099 Preclinical - Cell culture Actionable In a preclinical study, treatment with the combination of SHP099 and Xalkori (crizotinib) synergistically decreased viability of neuroblastoma cell lines harboring ALK F1174L in culture (PMID: 38032104). 38032104
ALK F1174L neuroblastoma sensitive Ceritinib + SHP099 Preclinical - Cell culture Actionable In a preclinical study, treatment with the combination of SHP099 and Zykadia (ceritinib) decreased invasion and synergistically decreased viability of neuroblastoma cell lines harboring ALK F1174L in culture (PMID: 38032104). 38032104
ALK F1174L neuroblastoma sensitive Lorlatinib + SHP099 Preclinical - Cell culture Actionable In a preclinical study, treatment with the combination of SHP099 and Lorbrena (lorlatinib) decreased invasion and synergistically decreased viability of neuroblastoma cell lines harboring ALK F1174L in culture (PMID: 38032104). 38032104
ALK F1174L neuroblastoma sensitive SHP099 Preclinical - Cell culture Actionable In a preclinical study, SHP099 decreased viability of neuroblastoma cell lines harboring ALK F1174L in culture (PMID: 38032104). 38032104