Case report: ATIC-ALK fusion in infant-type hemispheric glioma and response to lorlatinib

• Type of Material: Article
• Authors: Shubin Shahab, Emory University; Matthew Schniederjan, Emory University; Jose Velazquez Vega, Emory University; Stephen Little, Emory University; Andrew Reisner, Emory University; Tobey MacDonald, Emory University; Dolly Aguilera, Emory University
• Language: English
• Date: 2023-02-24
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Shahab, Schniederjan, Vega, Little, Reisner, MacDonald and Aguilera.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fonc.2023.1123378
• Title of Journal or Parent Work: FRONTIERS IN ONCOLOGY
• Volume: 13
• Start Page: 1123378
• End Page: 1123378
• Grant/Funding Information: Sequencing costs were covered by the Aflac Precision Medicine Program, which receives generous support from the CURE Childhood Cancer Foundation.
• Keywords: infant-type hemispheric glioma; Oncology; LARGE-CELL LYMPHOMA; ALK fusion; high grade glioma; lorlatinib; Science & Technology; case report; KINASE; ANAPLASTIC LYMPHOMA; Life Sciences & Biomedicine

Abstract

Introduction: Infant type hemispheric gliomas are a rare tumor with unique molecular characteristics. In many cases these harbor mutations in receptor tyrosine kinase pathways and respond to targeted therapy. Here we describe the case of an infant with this type of tumor with a novel ATIC-ALK fusion that has responded dramatically to the ALK inhibitor lorlatinib, despite being refractory to standard chemotherapy. Case description: The infant was initially treated with standard chemotherapy and found to have an ATIC-ALK fusion. When surveillance imaging revealed progressive disease, the patient was switched to the ALK-inhibitor lorlatinib at 47 mg/m2/day. The patient demonstrated a significant clinical and radiographic response to the ALK inhibitor lorlatinib after just 3 months of treatment and a near complete response by 6 months of therapy. Conclusion: The ALK inhibitor lorlatinib is an effective targeted therapy in infant type hemispheric glioma patients harboring ATIC-ALK fusion.