Complete and durable response to crizotinib in a patient with malignant pleural mesothelioma harboring CD74-ROS1 fusion

Our plain-English summary of Complete and durable response to crizotinib in a patient with malignant pleural mesothelioma harboring CD74-ROS1 fusion, by X. Xie, M. You, E. Meng, et al (Journal of Cancer Research and Clinical Oncology, 2022).

The study

• Authors: X. Xie, M. You, E. Meng, S. Wang, B. Niu, W. Huang
• Journal: Journal of Cancer Research and Clinical Oncology
• Published: 2022;148(9):2561-2566
• Type of article: Case report, Letter
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare and deadly malignancy with an extremely poor prognosis. The median overall survival (OS) of this disease is 12-18 months. However, the oncogenic driver mutations of MPM are rarely understood, and the targeted therapy for it is still under investigation. In this report, we describe a case of MPM with CD74-ROS1 fusion who obtains complete and durable response after receiving crizotinib. By the time of submission, the progression-free survival (PFS) with crizotinib has been 6.0 years, and the patient has survived for 7.6 years. Currently, he is still in complete remission (CR). To the best of our knowledge, this case represents the first report of CD74-ROS1 fusion identified in MPM. Meanwhile, it is also the first report of complete and long-term response to crizotinib in a patient with MPM positive for CD74-ROS1 fusion. This case report might contribute to the tumorigenesis and targeted therapy of this deadly disease.

© 2022. The Author(s).

In plain English

This letter to the editors was a case report about one patient with malignant pleural mesothelioma. In 2014 a 19-year-old man with chest pain had surgery to remove a tumor, which was diagnosed as stage II epithelioid malignant pleural mesothelioma. By the patient's own account, he had no history of exposure to asbestos and no family history of malignant tumors. After surgery he received chemotherapy with pemetrexed and cisplatin. In 2015 the cancer returned in a chest lymph node. It first shrank and then grew again during chemotherapy with pemetrexed and carboplatin. Testing of the tumor found a ROS1 gene fusion, and later sequencing identified it as a CD74-ROS1 fusion. From February 2016 the patient took the oral drug crizotinib. The lymph node shrank, and by December 2020 it was no longer visible on CT. At submission the patient had gone 6.0 years on crizotinib without progression, had survived 7.6 years, and was still in complete remission. The authors concluded that the case illustrates the potential role of genomic testing and targeted therapy in selected cases of mesothelioma.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (letter to the editors) of a single patient
• Who was studied: One 19-year-old male patient, first admitted to a local hospital in 2014 with chest pain. The authors' department is at The First Hospital of Putian, China.
• Exposure: By the patient's own account, he had no history of asbestos exposure. The treatment described was the oral targeted drug crizotinib, given as second-line therapy after earlier platinum-pemetrexed chemotherapy.
• Main results:
  • The surgically removed tumor was epithelioid malignant pleural mesothelioma, diagnosed as stage II (pT2NxM0).
  • After relapse in a mediastinal lymph node, chemotherapy with pemetrexed and carboplatin at first shrank the node from 3.94 cm × 4.16 cm to 1.0 cm in diameter. After six cycles the node had enlarged again (progressive disease).
  • RT-PCR testing of the tumor tissue found no EGFR mutations, MET amplifications or ALK fusions, but did find a ROS1 fusion.
  • Next-generation sequencing in August 2021 (599-gene panel) identified a CD74-ROS1 fusion, made of exons 1 to 7 of CD74 and exons 33 to 43 of ROS1.
  • On crizotinib, started February 2016, the mediastinal lymph node shrank by June 2016 (partial remission) and had disappeared on CT by December 27, 2020 (complete remission).
  • At submission, progression-free survival on crizotinib was 6.0 years and overall survival was 7.6 years. The patient was still in complete remission.
• The authors' conclusion: The authors concluded that this case illustrates the potential role of genomic testing and targeted therapy in selected cases of malignant pleural mesothelioma. They suggested it may highlight genomic testing especially in younger patients without an inherited or familial syndrome or without previous asbestos exposure.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, ROS1, Prognosis, Median Overall Survival, Targeted Therapy, Progression-Free Survival, Carcinogenesis.

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