• Irfan Ismaili University Clinic of Pulmonology and Allergology, Skopje, North Macedonia
  • Vesna Pachoska Stojchevska University Clinic of Pulmonology and Allergology, Skopje, North Macedonia
  • Olivera Gjeorgjieva Janev University Clinic of Rheumatology, Skopje, North Macedonia


Non small cell lung carcinoma (NSCLC) is a type of lung carcinoma that slowly grows within the lung
tissue, thus it is often diagnosed lately when the disease has already progressed and passed to other
body organs and/or lymph nodes. This makes NSCLC in most of the cases inoperable at the exact
moment of diagnosing, which leads to a necessity of using a chemotherapy that has the purpose of
narrowing the extended masses in the lungs and/or near/further metastases. Alectinib is a tyrosine-
kinase inhibitor (TKI) that is currently being used as a first line target therapy in treating the
inoperable ALK rearranged NSCLC, but still the effectiveness of the treatment is not definitely known
and examined. Herein, we report a case of a 51-year-old male patient presented to our hospital with
hemoptysis for 2 weeks. Contrast-enhanced computerized tomography (CT) of the chest showed an
approximately 28x23 mm soft tissue mass infiltrating into the lumen of the right bronchus and causing
obstruction. On the same side at the base, a hypodense nodule of 19 mm with some surrounding
pneumonic reaction and irregular contours was detected. Several significant lymph nodes were detected
in the hilar and mediastinal regions. Transobronchial biopsy of the mass showed pulmonary
adenocarcinoma and immunohistochemical testing results confirmed ALK rearrangements. TKI
alectinib was given at a dosage of 600mg twice per day for 13 cycles, achieving a complete response of
the disease with complete regression of the mass in the right bronchus, complete regression of the right
nodule and hilar and mediastinal lymph nodes were not detected after treatment . The patient
continued to receive alectinib and did not report any specific discomfort at his 13 month follow-up.

Keywords: NSCLC, Lung adenocarcinoma, ALK rearrangement, TKIs, Alectinib


1. he IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming
(Eighth) Edition of the TNM Classification. Goldstraw, P., Chansky, K., Crowley, J., Rami-Porta, R., Asamura, H.,
Eberhardt,0 W. E., et al. 2016.
2. Neoadjuvant Chemotherapy for Stage IIIA-N2 Non-small Cell Lung Cancer.Ann. . De Marinis, F., Gebbia, V.,
and De Petris, L. (. s.l. : Oncol.16 (Suppl. 4), iv116–122. doi:10.1093/annonc/mdi920 , 2005.
3. Preoperative Chemotherapy for Non-small-cell Lung Cancer: a Systematic Review and Meta-Analysis of
Individual Participant Data. . Group, NSCLC Meta-analysis Collaborative. s.l. : Lancet 383 (9928), 1561–1571.
doi:10.1016/S0140-6736(13)62159-5 , 2014.
4. Translocations involving anaplastic lymphoma kinase (ALK). Oncogene; 20: 5623– 37. Duyster J, Bai RY,
Morris SW. s.l. : Translocations involving anaplastic lymphoma kinase (ALK). Oncogene; 20: 5623– 37., 2001.
5. Second- and third-generation ALK inhibitors for non-small cell lung cancer. Wu JJ, Savooji J, Liu DL. s.l. : J
Hematol Oncol , 2016.
6. ALK-rearrangement in non-small-cell lung cancer (NSCLC). Xue Du, Yun Shao, Hai-Feng Qin, Yan-Hong Tai,
Hong-Jun Gao. s.l. : Thoracic Cancer , 2018.
7. ALK receptor tyrosine kinase promotes cell growth and neurite outgrowth. Motegi A, Fujimoto J, Kotani M,
Sakuraba H, Yamamoto. s.l. : J Cell Sci; 117: 3319– 29., 2004.
8. Molecular characterization of ALK, a receptor tyrosine kinase expressed specifically in the nervous system. .
Iwahara T, Fujimoto J, Wen D et al. s.l. : Oncogene; 14: 439– 49., 1997.
9. Comparison between immunocytochemistry, FISH and NGS for ALK and ROS1 rearrangement detection in
cytological samples. . Frankel, D., et al. s.l. : Int. J. Mol. Sci., 23, 10556. , 2022.
10. ALK+ anaplastic large cell lymphoma (ALCL)-derived exosomes carry ALK signaling proteins and interact with
tumor microenvironment. Chioureas, D., et al. s.l. : Cancers, 14, 2939. , 2022.
11. The transcriptional roles of ALK fusion proteins in tumorigenesis. . Ducray, S.P., et al. s.l. : Cancers, 11, 1074.
, 2019.
12. Guideline., The Japanese Lung Cancer Society. Available online: https://www.haigan.gr.jp/guideline/2022/
[Online] 2022.
13. Non–small cell lung cancer: Epidemiology, screening, diagnosis, and treatment. Duma, N., Santana-Davila,
R. and Molina, J.R. s.l. : Mayo Clin. Proc, 94, 1623–1640. , 2019.
14. Targeting EML4-ALK driven non-small cell lung cancer (NSCLC). . Morán, T., et al. s.l. : Transl. Lung Cancer
Res. 128–141. , 2013.
15. Mixed responses to first-line alectinib in non-small cell lung cancer patients with rare ALK gene fusions:.
Mengnan Li, Zhou An, Qiusu Tang, Yutong Ma, Junrong Yan, Songan Chen, Yina Wang. s.l. : A case series and
literature review. PMID: 34541785. PMCID: PMC8500978. DOI: 10.1111/jcmm.16897.
16. Immunotherapy in NSCLC: a promising and revolutionary weapon. Rolfo C, Caglevic C, Santarpia M, Araujo
A, Giovannetti E, Gallardo CD., et al. s.l. : dv Exp Med Biol. 995:97–125. doi: 10.1007/978-3-319-53156-4_5,
17. Alectinib in the treatment of ALK- positive non-small cell lung cancer: an update on its properties, efficacy,
safety and place in therapy . Tiziana Vavala., Silvia Novello. s.l. : Therapeutic Advacnces in Medical Oncology ,
18. Cancer statistics. Siegel RL, Miller KD, Jemal A. s.l. : CA Cancer J Clin. (2018) 68:7–30. doi:
10.3322/caac.21442, 2018.
19. The morphological and molecular diagnosis of lung cancer. I., Petersen. s.l. : Deutsch Arztebl Int.
108:525–31. doi: 10.3238/arztebl.2011.0525, 2011.
20. Targeted therapies in cancer: where are we going? Giovannetti EA., Rodriguez J. s.l. : Cancer Drug Resist.
1:82–6. doi: 10.20517/cdr.2018.05, 2018.
21. International association for the study of lung cancer/american thoracic society/european respiratory
society international multidisciplinary classification of lung adenocarcinoma. Travis WD, Brambilla E, Noguch,
M, Nicholson AG, Geisinger KR, Yatabe Y, et al. s.l. : J Thorac Oncol. 6:244–85. doi:
10.1097/JTO.0b013e318206a221, 2011.
22. Genome-wide association study of lung adenocarcinoma in East Asia and comparison with a European
population. Jianxin Shi, Kouya Shiraishi, Jiyeon Choi, Keitaro Matsuo, Tzu-Yu Chen, Juncheng Dai, Rayjean J.
Hung, Kexin Chen, Xiao-Ou Shu, Young Tae Kim, Maria Teresa Landi, Dongxin Lin, Wei Zheng, Zhihua Yin,
Baosen Zhou, Bao Song, Jiucun Wang, Wei Jie Seow, Lei So. s.l. : Nature Communications volume 14, Article
number: 3043 , 2023.
23. Adenosquamous carcinoma of the lung. Chenghui Li1, 2 and Hongyang Lu2,3. s.l. : Onco Targets Ther. ,
24. Diagnosis and Treatment of ALK Positive NSCLC. Riely, Kathryn C. Arbour and Gregory J. s.l. : Hematol
Oncol Clin North Am. 2017 Feb; 31(1): 101–111., 2018.
25. Global Survey of Phosphotyrosine Signaling Identifies Oncogenic Kinases in Lung Cancer. Rikova K, Guo A,
Zeng Q, et al. s.l. : Cell.;131(6):1190–1203. doi: 10.1016/j.cell.2007.11.025., 2007.
26. Unique Clinicopathologic Features Characterize ALK-Rearranged Lung Adenocarcinoma in the Western
Population. Rodig SJ, Mino-Kenudson M, Dacic S, et al. s.l. : Clin Cancer Res.;15(16):5216–5223. doi:
10.1158/1078-0432.CCR-09-0802., 2009.
27. Alectinib: A Review in Advanced, ALK-Positive NSCLC. Dhillon, Julia Paik & Sohita. s.l. : Drugs 78,
1247–1257. https://doi.org/10.1007/s40265-018-0952-0, 2018.
28. Alectinib versus Crizotinib in Untreated ALK-Positive Non–Small-Cell Lung Cancer. Solange Peters, M.D.,
Ph.D., D. Ross Camidge, M.D., Ph.D., Alice T. Shaw, M.D., Ph.D., Shirish Gadgeel, M.D., Jin S. Ahn, M.D., Dong-
Wan Kim, M.D., Ph.D., Sai-Hong I. Ou, M.D., Ph.D., Maurice Pérol, M.D., Rafal Dziadziuszko, M.D., Rafael
Rosell, M.D., Ph. s.l. : N Engl J Med ; 377:829-838, 2017.
How to Cite
ISMAILI, Irfan; STOJCHEVSKA, Vesna Pachoska; JANEV, Olivera Gjeorgjieva. EXCELLENT RESPONSE TO ALECTINIB IN ALK-POSITIVE NSCLC ADENOCARCINOMA-A CASE REPORT AND LITERATURE REVIEW. Journal of Morphological Sciences, [S.l.], v. 6, n. 2, p. 140-146, nov. 2023. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/512>. Date accessed: 28 nov. 2023.