Concomitant mutations of echinoderm microtubule-associated protein-like 4 (EML4) anaplastic lymphoma kinase (ALK) translocation and epidermal growth factor receptor (EGFR) can be found rarely in lung adenocarcinoma. We present a case of harboring EML4/ALK rearrangement lung adenocarcinoma who previously received erlotinib. A 42-year-old male who was diagnosed as lung adenocarcinoma and received many series of cytotoxic regimens. A partial tumor response was achieved with crizotinib after failure with erlotinib therapy. After progressive disease, biopsy of new liver lesion showed EML4/ALK rearrangement. Thus crizotinib was administrated. A partial tumor response was achieved with crizotinib after failure with erlotinib therapy and chemotherapy. We conclude that it is important to evaluate for EML4/ALK rearrangement even the patient has EGFR mutation. Concomitant EGFR exon 18 and EML4-ALK mutations can occur in lung adenocarcinoma. EML4/ALK related TKIs may be more effective in these patients.

PURPOSE:Metastatic colorectal cancer (mCRC) is a lethal disease and fluorouracil-leucovorin-irinotecan (FOLFIRI) plus bevacizumab (bev) is a standard approach. Hence, there is a strong need for identifying new prognostic factors to show the efficacy of FOLFIRI-bev. METHODS:This is a retrospective study including patients (n = 90) with mCRC from two centers in Turkey. Neutrophil/lymphocyte (N/L) ratio, platelet count, albumin, and C-reactive protein (CRP) were recorded before FOLFIRI-bev therapy. The efficacy of these factors on progression-free survival (PFS) was analyzed with Kaplan Meier and Cox regression analysis. And the cutoff value of N/L ratio was analyzed with ROC analysis. RESULTS:The median age was 56 years (range 21-80). Forty-seven percent of patients with N/L ratio >2.5 showed progressive disease versus 43 % in patients with N/L ratio <2.5 (p = 0.025). The median PFS was 8.1 months for the patients with N/L ratio >2.5 versus 13.5 months for the patients with N/L ratio <2.5 (p = 0.025). At univariate Cox regression analysis, high baseline neutrophil count, LDH, N/L ratio, and CRP were all significantly associated with poor prognosis. At multivariate Cox regression analysis, CRP was confirmed to be a better independent prognostic factor. CRP variable was divided into above the upper limit of normal (ULN) and normal value. The median PFSs of the patients with normal and above ULN were 11.3 versus 5.8 months, respectively (p = 0.022). CONCLUSIONS:CRP and N/L ratio are potential predictors for advanced mCRC treated with FOLFIRI-bev.

1Necmettin Erbakan University Meram Medical Faculty Department of Internal Medicine, Konya, Turkey 2Necmettin Erbakan University Meram Medical Faculty Department of Medical Oncology, Konya, Turkey 3Akdeniz University Medical Faculty Department of Medical Oncology, Antalya, Turkey 4Necmettin Erbakan University Meram Medical Faculty Department of Pathology, Konya, Turkey 5Akdeniz University, Medical Faculty Department of Pathology, Antalya, Turkey