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Ref Type Journal Article
PMID (31446141)
Authors Horn L, Whisenant JG, Wakelee H, Reckamp KL, Qiao H, Leal TA, Du L, Hernandez J, Huang V, Blumenschein GR, Waqar SN, Patel SP, Nieva J, Oxnard GR, Sanborn RE, Shaffer T, Garg K, Holzhausen A, Harrow K, Liang C, Lim LP, Li M, Lovly CM
Title Monitoring Therapeutic Response and Resistance: Analysis of Circulating Tumor DNA in Patients With ALK+ Lung Cancer.
URL
Abstract Text Despite initial effectiveness of ALK receptor tyrosine kinase inhibitors (TKIs) in patients with ALK+ NSCLC, therapeutic resistance will ultimately develop. Serial tracking of genetic alterations detected in circulating tumor DNA (ctDNA) can be an informative strategy to identify response and resistance. This study evaluated the utility of analyzing ctDNA as a function of response to ensartinib, a potent second-generation ALK TKI.Pre-treatment plasma was collected from 76 patients with ALK+ NSCLC who were ALK TKI-naive or had received prior ALK TKI, and analyzed for specific genetic alterations. Longitudinal plasma samples were analyzed from a subset (n = 11) of patients. Analysis of pre-treatment tumor biopsy specimens from 22 patients was compared with plasma.Disease-associated genetic alterations were detected in 74% (56 of 76) of patients, the most common being EML4-ALK. Concordance of ALK fusion between plasma and tissue was 91% (20 of 22 blood and tissue samples). Twenty-four ALK kinase domain mutations were detected in 15 patients, all had previously received an ALK TKI; G1269A was the most prevalent (4 of 24). Patients with a detectable EML4-ALK variant 1 (V1) fusion had improved response (9 of 17 patients; 53%) to ensartinib compared to patients with EML4-ALK V3 fusion (one of seven patients; 14%). Serial changes in ALK alterations were observed during therapy.Clinical utility of ctDNA was shown, both at pre-treatment by identifying a potential subgroup of ALK+ NSCLC patients who may derive more benefit from ensartinib and longitudinally by tracking resistance. Prospective application of this technology may translate to improved outcomes for NSCLC patients treated with ALK TKIs.

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Molecular Profile Treatment Approach
Gene Name Source Synonyms Protein Domains Gene Description Gene Role
Therapy Name Drugs Efficacy Evidence Clinical Trials
Drug Name Trade Name Synonyms Drug Classes Drug Description
Gene Variant Impact Protein Effect Variant Description Associated with drug Resistance
Molecular Profile Indication/Tumor Type Response Type Therapy Name Approval Status Evidence Type Efficacy Evidence References
EML4 - ALK ALK C1156Y Advanced Solid Tumor sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited viability of a cell line expressing EML4-ALK with ALK C1156Y in culture (PMID: 31446141). 31446141
EML4 - ALK ALK S1206F lung non-small cell carcinoma predicted - resistant Ensartinib Case Reports/Case Series Actionable In a clinical case study, ALK S1206F, along with EML4-ALK (v3), was identified in plasma cell-free DNA in a patient with non-small cell lung cancer harboring EML4-ALK (v5) who progressed on Ensartinib (X-396) treatment (PMID: 31446141). 31446141
EML4 - ALK ALK F1245C Advanced Solid Tumor sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited viability of a cell line expressing EML4-ALK with ALK F1245C in culture (PMID: 31446141). 31446141
EML4 - ALK ALK E1210K Advanced Solid Tumor sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited viability of a cell line expressing EML4-ALK with ALK E1210K in culture (PMID: 31446141). 31446141
EML4 - ALK ALK L1152R Advanced Solid Tumor sensitive Ensartinib Preclinical - Cell culture Actionable In a preclinical study, Ensartinib (X-396) inhibited viability of a cell line expressing EML4-ALK with ALK L1152R in culture (PMID: 31446141). 31446141
EML4 - ALK ALK F1174V Advanced Solid Tumor sensitive Ensartinib Preclinical - Cell culture Actionable In a preclinical study, Ensartinib (X-396) inhibited viability of a cell line expressing EML4-ALK with ALK F1174V in culture (PMID: 31446141). 31446141
EML4 - ALK ALK F1174C Advanced Solid Tumor sensitive Brigatinib Preclinical - Cell culture Actionable In a preclinical study, Alunbrig (brigatinib) inhibited viability of a cell line expressing EML4-ALK with ALK F1174C in culture (PMID: 31446141). 31446141
EML4 - ALK ALK V1180L Advanced Solid Tumor sensitive Brigatinib Preclinical - Cell culture Actionable In a preclinical study, Alunbrig (brigatinib) inhibited viability of a cell line expressing EML4-ALK with ALK V1180L in culture (PMID: 31446141). 31446141
EML4 - ALK ALK L1198F Advanced Solid Tumor conflicting Ceritinib Preclinical - Cell culture Actionable In a preclinical study, a cell line expressing EML4-ALK with ALK L1198F was resistant to Zykadia (ceritinib) in culture (PMID: 31446141). 31446141
EML4 - ALK ALK G1202del Advanced Solid Tumor resistant Alectinib Preclinical - Cell culture Actionable In a preclinical study, a cell line expressing EML4-ALK with ALK G1202del was resistant to Alecensa (alectinib) in culture (PMID: 31446141). 31446141
EML4 - ALK ALK G1123S Advanced Solid Tumor sensitive Crizotinib Preclinical - Cell culture Actionable In a preclinical study, Xalkori (crizotinib) inhibited viability of a cell line expressing EML4-ALK with ALK G1123S in culture (PMID: 31446141). 31446141
EML4 - ALK ALK V1180L Advanced Solid Tumor sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited viability of a cell line expressing EML4-ALK with ALK V1180L in culture (PMID: 31446141). 31446141
EML4 - ALK ALK F1174V Advanced Solid Tumor sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited viability of a cell line expressing EML4-ALK with ALK F1174V in culture (PMID: 31446141). 31446141
EML4 - ALK ALK G1123S Advanced Solid Tumor sensitive Alectinib Preclinical - Cell culture Actionable In a preclinical study, Alecensa (alectinib) inhibited viability of a cell line expressing EML4-ALK with ALK G1123S in culture (PMID: 31446141). 31446141
EML4 - ALK ALK G1123S Advanced Solid Tumor sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited viability of a cell line expressing EML4-ALK with ALK G1123S in culture (PMID: 31446141). 31446141
EML4 - ALK ALK E1210K Advanced Solid Tumor conflicting Alectinib Preclinical - Cell culture Actionable In a preclinical study, a cell line expressing EML4-ALK with ALK E1210K was resistant to Alecensa (alectinib) in culture (PMID: 31446141). 31446141
EML4 - ALK ALK F1245C Advanced Solid Tumor sensitive Brigatinib Preclinical - Cell culture Actionable In a preclinical study, Alunbrig (brigatinib) inhibited viability of a cell line expressing EML4-ALK with ALK F1245C in culture (PMID: 31446141). 31446141
EML4 - ALK ALK L1152R Advanced Solid Tumor sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited viability of a cell line expressing EML4-ALK with ALK L1152R in culture (PMID: 31446141). 31446141
EML4 - ALK ALK S1206Y Advanced Solid Tumor sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited viability of a cell line expressing EML4-ALK with ALK S1206Y in culture (PMID: 31446141). 31446141
EML4 - ALK ALK G1202del Advanced Solid Tumor sensitive Lorlatinib Preclinical - Cell culture Actionable In a preclinical study, Lorbrena (lorlatinib) inhibited viability of a cell line expressing EML4-ALK with ALK G1202del in culture (PMID: 31446141). 31446141
EML4 - ALK ALK V1180L Advanced Solid Tumor sensitive Ensartinib Preclinical - Cell culture Actionable In a preclinical study, Ensartinib (X-396) inhibited viability of a cell line expressing EML4-ALK with ALK V1180L in culture (PMID: 31446141). 31446141
EML4 - ALK ALK V1180L Advanced Solid Tumor sensitive Ceritinib Preclinical - Cell culture Actionable In a preclinical study, Zykadia (ceritinib) inhibited viability of a cell line expressing EML4-ALK with ALK V1180L in culture (PMID: 31446141). 31446141
EML4 - ALK ALK E1210K Advanced Solid Tumor resistant Ensartinib Preclinical - Cell culture Actionable In a preclinical study, a cell line expressing EML4-ALK with ALK E1210K was resistant to Ensartinib (X-396) in culture (PMID: 31446141). 31446141
ALK E1210K lung non-small cell carcinoma predicted - resistant Ensartinib Case Reports/Case Series Actionable In a clinical case study, a patient with non-small cell lung cancer progressed on Ensartinib (X-396) treatment and was found to have acquired ALK E1210K and lost ALK L1152V and G1269A in plasma cell-free DNA (PMID: 31446141). 31446141
EML4 - ALK ALK G1123S Advanced Solid Tumor resistant Ceritinib Preclinical - Cell culture Actionable In a preclinical study, a cell line expressing EML4-ALK with ALK G1123S was resistant to Zykadia (ceritinib) in culture (PMID: 31446141). 31446141
ALK rearrange ALK T1151M lung non-small cell carcinoma predicted - sensitive Ensartinib Case Reports/Case Series Actionable In a clinical case study, Ensartinib (X-396) treatment resulted in a partial response in a non-small cell lung cancer patient harboring a non-coding ALK rearrangement with ALK T1151M (PMID: 31446141). 31446141
EML4 - ALK ALK L1152R Advanced Solid Tumor sensitive Alectinib Preclinical - Cell culture Actionable In a preclinical study, Alecensa (alectinib) inhibited viability of a cell line expressing EML4-ALK with ALK L1152R in culture (PMID: 31446141). 31446141
EML4 - ALK ALK G1123S Advanced Solid Tumor sensitive Brigatinib Preclinical - Cell culture Actionable In a preclinical study, Alunbrig (brigatinib) inhibited viability of a cell line expressing EML4-ALK with ALK G1123S in culture (PMID: 31446141). 31446141
EML4 - ALK ALK L1196M lung non-small cell carcinoma predicted - sensitive Ensartinib Case Reports/Case Series Actionable In a clinical case study, Ensartinib (X-396) treatment resulted in a partial response in a non-small cell lung cancer patient harboring EML4-ALK (v5) with ALK L1196M and stable disease in another patient harboring EML4-ALK (v2) with ALK L1196M (PMID: 31446141). 31446141
EML4 - ALK ALK G1123S Advanced Solid Tumor sensitive Ensartinib Preclinical - Cell culture Actionable In a preclinical study, Ensartinib (X-396) inhibited viability of a cell line expressing EML4-ALK with ALK G1123S in culture (PMID: 31446141). 31446141
EML4 - ALK ALK G1202R Advanced Solid Tumor resistant Ensartinib Preclinical - Cell culture Actionable In a preclinical study, a cell line expressing EML4-ALK with ALK G1202R was resistant to Ensartinib (X-396) in culture (PMID: 31446141). 31446141
EML4 - ALK ALK L1198F Advanced Solid Tumor sensitive Ensartinib Preclinical - Cell culture Actionable In a preclinical study, Ensartinib (X-396) inhibited viability of a cell line expressing EML4-ALK with ALK L1198F in culture (PMID: 31446141). 31446141
EML4 - ALK ALK G1269A Advanced Solid Tumor resistant Ensartinib Preclinical - Cell culture Actionable In a preclinical study, a cell line expressing EML4-ALK with ALK G1269A was resistant to Ensartinib (X-396) in culture (PMID: 31446141). 31446141
ALK L1152V ALK G1269A lung non-small cell carcinoma predicted - sensitive Ensartinib Case Reports/Case Series Actionable In a clinical case study, Ensartinib (X-396) treatment resulted in a partial response in a patient with non-small cell lung cancer harboring ALK L1152V and ALK G1269A (PMID: 31446141). 31446141
EML4 - ALK ALK C1156Y Advanced Solid Tumor sensitive Ensartinib Preclinical - Cell culture Actionable In a preclinical study, Ensartinib (X-396) inhibited viability of a cell line expressing EML4-ALK with ALK C1156Y in culture (PMID: 31446141). 31446141