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Case Report Open Access

Alectinib efficacy in advanced lung adenocarcinoma with coexistence of a novel ALK-MTUS2 and STRN3-ALK double fusion: A case report and literature review

  • Authors:
    • Xirui Qiu
    • Yu Wei
    • Xiaoxiao Wang
    • Siyan Xu
    • Yaru Zhang
    • Hailang He
    • Xianmei Zhou
  • View Affiliations / Copyright

    Affiliations: Department of Respiratory and Critical Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China, Clinical Research Institute, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu 211800, P.R. China
    Copyright: © Qiu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 432
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    Published online on: July 7, 2025
       https://doi.org/10.3892/ol.2025.15178
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Abstract

In total, >90 unique anaplastic lymphoma kinase (ALK) rearrangement fusion partners have been identified, each with a unique sensitivity to ALK tyrosine kinase inhibitors, rendering targeted therapy challenging. In the present study, the efficacy of alectinib in a patient with advanced lung adenocarcinoma harbouring a novel ALK-microtubule-associated tumour suppressor candidate 2 (MTUS2) fusion and a rare Striatin 3 (STRN3)-ALK fusion was assessed. A 20-year-old non-smoker was hospitalised with a persistent cough. Subsequent positron emission tomography/computed tomography revealed a tumour in the right lower lobe, with mediastinal, hilar, lymph node and bone metastases. Cranial magnetic resonance imaging also revealed a cerebral metastasis. Bronchoscopic biopsy revealed an adenocarcinoma in the right lower lobe nodule, resulting in a clinical stage IVB diagnosis (cT2bN3bM1c). Targeted next-generation sequencing of tissue and blood samples revealed ALK-MTUS2 and STRN3-ALK fusions. The patient was treated with alectinib as the first-line therapy and a durable partial response was achieved after 3 months, with disappearance of the brain metastases. To the best of our knowledge, the present study represents the first discovery of simultaneous ALK-MTUS2 and STRN3-ALK fusions. The clinical outcome offers potential therapeutic options for patients with rare ALK rearrangements and underscores the necessity for further research on the functions of these fusions.
View Figures

Figure 1

Dynamic monitoring via CT of the
patient's response to alectinib. (A) CT shows a large mass in the
right lower lobe of the lung at baseline. CT shows partial response
after (B) 3, (C) 6, (D) 11 and (E) 15 months of alectinib
treatment. (F) CT shows an enlarged right hilar lymph node. CT
shows a significant reduction in tumour size after (G) 3, (H) 6,
(I) 11 and (J) 15 months of alectinib treatment. CT, computed
tomography.

Figure 2

A fusion variant of STRN3 intron 3
with ALK intron 19 was identified by NGS analysis and was
considered to cause a rare STRN3-ALK fusion transcript in which
exon 3 of STRN3 was fused to exon 20 of ALK (S3:A20). (A)
Paired-end sequencing data indicated the somatic intrachromosomal
STRN-ALK fusion, as demonstrated by the Integrative Genomics
Viewer. (B) Diagram depicting the STRN3-ALK fusion (S3:A20). CC,
coiled coil domain; Cav, caveolin-binding domain; Chr, chromosome;
NGS, next-generation sequencing; ALK, anaplastic lymphoma kinase;
STRN3, Striatin 3.

Figure 3

Tumour tissue histological typing. (A)
The histological typing identified adenocarcinoma of the lung with
acinar and solid patterns (haematoxylin-eosin; magnification,
×400). (B) Immunohistochemical analysis showed diffuse strong
positivity for anaplastic lymphoma kinase (D5F3) (magnification,
×200).
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Copy and paste a formatted citation
Spandidos Publications style
Qiu X, Wei Y, Wang X, Xu S, Zhang Y, He H and Zhou X: Alectinib efficacy in advanced lung adenocarcinoma with coexistence of a novel ALK-MTUS2 and STRN3-ALK double fusion: A case report and literature review. Oncol Lett 30: 432, 2025.
APA
Qiu, X., Wei, Y., Wang, X., Xu, S., Zhang, Y., He, H., & Zhou, X. (2025). Alectinib efficacy in advanced lung adenocarcinoma with coexistence of a novel ALK-MTUS2 and STRN3-ALK double fusion: A case report and literature review. Oncology Letters, 30, 432. https://doi.org/10.3892/ol.2025.15178
MLA
Qiu, X., Wei, Y., Wang, X., Xu, S., Zhang, Y., He, H., Zhou, X."Alectinib efficacy in advanced lung adenocarcinoma with coexistence of a novel ALK-MTUS2 and STRN3-ALK double fusion: A case report and literature review". Oncology Letters 30.3 (2025): 432.
Chicago
Qiu, X., Wei, Y., Wang, X., Xu, S., Zhang, Y., He, H., Zhou, X."Alectinib efficacy in advanced lung adenocarcinoma with coexistence of a novel ALK-MTUS2 and STRN3-ALK double fusion: A case report and literature review". Oncology Letters 30, no. 3 (2025): 432. https://doi.org/10.3892/ol.2025.15178
Copy and paste a formatted citation
x
Spandidos Publications style
Qiu X, Wei Y, Wang X, Xu S, Zhang Y, He H and Zhou X: Alectinib efficacy in advanced lung adenocarcinoma with coexistence of a novel ALK-MTUS2 and STRN3-ALK double fusion: A case report and literature review. Oncol Lett 30: 432, 2025.
APA
Qiu, X., Wei, Y., Wang, X., Xu, S., Zhang, Y., He, H., & Zhou, X. (2025). Alectinib efficacy in advanced lung adenocarcinoma with coexistence of a novel ALK-MTUS2 and STRN3-ALK double fusion: A case report and literature review. Oncology Letters, 30, 432. https://doi.org/10.3892/ol.2025.15178
MLA
Qiu, X., Wei, Y., Wang, X., Xu, S., Zhang, Y., He, H., Zhou, X."Alectinib efficacy in advanced lung adenocarcinoma with coexistence of a novel ALK-MTUS2 and STRN3-ALK double fusion: A case report and literature review". Oncology Letters 30.3 (2025): 432.
Chicago
Qiu, X., Wei, Y., Wang, X., Xu, S., Zhang, Y., He, H., Zhou, X."Alectinib efficacy in advanced lung adenocarcinoma with coexistence of a novel ALK-MTUS2 and STRN3-ALK double fusion: A case report and literature review". Oncology Letters 30, no. 3 (2025): 432. https://doi.org/10.3892/ol.2025.15178
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