Detection of EML4-ALK fusion gene and analysis of its clinical features in NSCLC patients with EGFR mutation

AIM: To detect the frequency of EML4-ALK fusion gene in non-small-cell lung cancer (NSCLC) patients who had epidermal growth factor receptor (EGFR) mutation, and to analyze the relationship between EML4-ALK fusion gene and clinical features. METHODS: One hundred and two Chinese patients with NSCLC were selected on the basis of one or more of the following characteristics: female, never/light smoking history and adenocarcinoma histology. The EML4-ALK fusion gene was identified by single-tube multiplex RT-PCR. In EML4-ALK-positive samples, exon 18 to 21 EGFR mutations and exon 1 and 2 KRAS (Kirsten rat sarcoma) mutations were detected by DNA direct sequencing after PCR amplification. RESULTS: Eight specimens (7.8%) were identified with EML4-ALK fusion genes from 102 NSCLC tissues. Of all positive cases, 7 were variant 1 (V1) and 1 was variant 2 (V2). In 8 EML4-ALK-positive samples, exon 18 to 21 EGFR and exon 1 and 2 KRAS were wild-types. Among 8 EML4-ALK-positive cases, 5 cases (5/8, 62.5%) were younger than the mean age. Six cases (6/8, 75%) were female and 7 cases (7/8, 87.5%) were non-smokers. Five cases (5/8, 62.5%) had adenocarcinoma histology. CONCLUSION: EML4-ALK fusion gene defines a new molecular subset of NSCLC with distinct characteristics. The EML4-ALK fusion gene is mutually exclusive to EGFR and KRAS mutations.