How would you approach first-line treatment in metastatic NSCLC for a patient with ALK-EML4 V3a/b variant and MSI-high status?
Both ALK and MSI-high status were noted on a liquid biopsy since there was not enough tissue available for molecular testing.
Some reports suggest lower sensitivity to ALK inhibitors with variant 3a/b (at least 1st and 2nd generation). Would this change your choice of starting with an ALK TKI?
1 Answer
Mednet MemberInvited Expert
Medical Oncology · University of Colorado Anschutz Medical Center
Answered on · Updated on
It's a good question. I would first confirm the MSI-high status using tissue-based testing. I would recommend a pathology re-review in light of these molecular findings, and consider the possibility that this could be metastatic colorectal cancer. While EML4-ALK fusions are most common in NSCLC, the...
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