Targeting ALK: a promising strategy for the treatment of non-small cell lung cancer, non-Hodgkin’s lymphoma, and neuroblastoma

Anaplastic lymphoma kinase (ALK) is a tyrosine kinase receptor that affects a number of biological and biochemical functions through normal ligand-dependent signaling. It has oncogenic functions in a number of tumors including non-small cell lung cancer (NSCLC), anaplastic large cell lymphoma, and neuroblastoma when altered by translocation or amplification or mutation. On August 2011, a small molecule inhibitor against ALK, crizotinib, was approved for therapy against NSCLC with ALK translocations. As we determine the molecular heterogeneity of tumors, the potential of ALK as a relevant therapeutic target in a number of malignancies has become apparent. This review will discuss some of the tumor types with oncogenic ALK alterations. The activity and unique toxicities of crizotinib are described, along with potential mechanisms of resistance and new therapies beyond crizotinib.

[1]  D. Levy,et al.  Stat3 is required for ALK-mediated lymphomagenesis and provides a possible therapeutic target , 2005, Nature Medicine.

[2]  M. Meyerson,et al.  Genome-Wide Analysis of Neuroblastomas using High-Density Single Nucleotide Polymorphism Arrays , 2007, PloS one.

[3]  S. Cedrés,et al.  ALK rearrangement in a selected population of advanced non-small cell lung cancer patients: FISH and inmunohistochemistry diagnostic methods, prevalence, and clinical outcomes. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  B. Falini,et al.  Nucleophosmin-anaplastic lymphoma kinase (NPM-ALK), a novel Hsp90-client tyrosine kinase: down-regulation of NPM-ALK expression and tyrosine phosphorylation in ALK(+) CD30(+) lymphoma cells by the Hsp90 antagonist 17-allylamino,17-demethoxygeldanamycin. , 2002, Cancer research.

[5]  H. Aburatani,et al.  Identification of the transforming EML4–ALK fusion gene in non-small-cell lung cancer , 2007, Nature.

[6]  R. Gascoyne,et al.  Anaplastic lymphoma kinase-positive diffuse large B-cell lymphoma: a rare clinicopathologic entity with poor prognosis. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  F. Westermann,et al.  High ALK Receptor Tyrosine Kinase Expression Supersedes ALK Mutation as a Determining Factor of an Unfavorable Phenotype in Primary Neuroblastoma , 2011, Clinical Cancer Research.

[8]  C. Messa,et al.  Crizotinib in anaplastic large-cell lymphoma. , 2011, The New England journal of medicine.

[9]  P. Jänne,et al.  Inhibition of ALK, PI3K/MEK, and HSP90 in murine lung adenocarcinoma induced by EML4-ALK fusion oncogene. , 2010, Cancer research.

[10]  Francesca Demichelis,et al.  EML4-ALK fusion lung cancer: a rare acquired event. , 2008, Neoplasia.

[11]  C. Powers,et al.  Pleiotrophin Signaling through Anaplastic Lymphoma Kinase Is Rate-limiting for Glioblastoma Growth* , 2002, The Journal of Biological Chemistry.

[12]  Roberto Piva,et al.  The anaplastic lymphoma kinase in the pathogenesis of cancer , 2008, Nature Reviews Cancer.

[13]  D N Shapiro,et al.  Fusion of a kinase gene, ALK, to a nucleolar protein gene, NPM, in non-Hodgkin's lymphoma. , 1994, Science.

[14]  A. Iafrate,et al.  Activity of IPI-504, a novel heat-shock protein 90 inhibitor, in patients with molecularly defined non-small-cell lung cancer. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  M. Djokic ALK− anaplastic large-cell lymphoma is clinically and immunophenotypically different from both ALK+ ALCL and peripheral T-cell lymphoma, not otherwise specified: report from the International Peripheral T-Cell Lymphoma Project , 2009 .

[16]  A. Iafrate,et al.  Prognostic versus predictive value of EML4-ALK translocation in metastatic non-small cell lung cancer. , 2010 .

[17]  S. Kroft,et al.  ALK-positive diffuse large B-cell lymphoma: report of four cases and review of the literature , 2007, Modern Pathology.

[18]  Y. Ishikawa,et al.  EML4-ALK lung cancers are characterized by rare other mutations, a TTF-1 cell lineage, an acinar histology, and young onset , 2009, Modern Pathology.

[19]  P. Włodarski,et al.  Oncogenic tyrosine kinase NPM/ALK induces activation of the rapamycin-sensitive mTOR signaling pathway , 2007, Oncogene.

[20]  H. Carén,et al.  High incidence of DNA mutations and gene amplifications of the ALK gene in advanced sporadic neuroblastoma tumours. , 2008, The Biochemical journal.

[21]  H. Varmus,et al.  Amplification of N-myc in untreated human neuroblastomas correlates with advanced disease stage. , 1984, Science.

[22]  Y. Ishikawa,et al.  Multiplex Reverse Transcription-PCR Screening for EML4-ALK Fusion Transcripts , 2008, Clinical Cancer Research.

[23]  Jeff Shrager,et al.  A Novel Classification of Lung Cancer into Molecular Subtypes , 2012, PloS one.

[24]  G. Delsol,et al.  Anaplastic Lymphoma Kinase Is a Dependence Receptor Whose Proapoptotic Functions Are Activated by Caspase Cleavage , 2006, Molecular and Cellular Biology.

[25]  Ling Tian,et al.  Activation of mammalian target of rapamycin signaling pathway contributes to tumor cell survival in anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. , 2006, Cancer research.

[26]  W. Klapper,et al.  Inhibition of Anaplastic Lymphoma Kinase (ALK) Activity Provides a Therapeutic Approach for CLTC-ALK-Positive Human Diffuse Large B Cell Lymphomas , 2011, PloS one.

[27]  Yuki Togashi,et al.  Identification of novel isoforms of the EML4-ALK transforming gene in non-small cell lung cancer. , 2008, Cancer research.

[28]  R. Lai,et al.  Pathobiology of ALK+ anaplastic large-cell lymphoma. , 2007, Blood.

[29]  D. Gary Gilliland,et al.  Activating mutations in ALK provide a therapeutic target in neuroblastoma , 2008, Nature.

[30]  S. Digumarthy,et al.  Clinical features and outcome of patients with non-small-cell lung cancer who harbor EML4-ALK. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[31]  Johan Vansteenkiste,et al.  Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[32]  P. Jänne,et al.  Discovery of 3,5-Diamino-1,2,4-triazole Ureas as Potent Anaplastic Lymphoma Kinase Inhibitors , 2011, ACS medicinal chemistry letters.

[33]  K. Elenitoba-Johnson,et al.  NPM-ALK signals through glycogen synthase kinase 3β to promote oncogenesis , 2012, Oncogene.

[34]  M. Wasik,et al.  Role of phosphatidylinositol 3-kinase-Akt pathway in nucleophosmin/anaplastic lymphoma kinase-mediated lymphomagenesis. , 2001, Cancer research.

[35]  R. Gascoyne,et al.  ALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements: report of 6 cases. , 2003, Blood.

[36]  S. Perkins,et al.  Intensive chemotherapy for systemic anaplastic large cell lymphoma in children and adolescents: Final results of children's cancer group study 5941 , 2009, Pediatric blood & cancer.

[37]  A. Look,et al.  Anaplastic lymphoma kinase: role in cancer pathogenesis and small-molecule inhibitor development for therapy , 2009, Expert review of anticancer therapy.

[38]  A. Jemal,et al.  Cancer statistics, 2011 , 2011, CA: a cancer journal for clinicians.

[39]  Derek Y. Chiang,et al.  EML4-ALK Fusion Gene and Efficacy of an ALK Kinase Inhibitor in Lung Cancer , 2008, Clinical Cancer Research.

[40]  Carlo Gambacorti-Passerini,et al.  Characterization of Some Molecular Mechanisms Governing Autoactivation of the Catalytic Domain of the Anaplastic Lymphoma Kinase* , 2008, Journal of Biological Chemistry.

[41]  W. Pao,et al.  EML4-ALK: honing in on a new target in non-small-cell lung cancer. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[42]  Robert Gray,et al.  Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. , 2006, The New England journal of medicine.

[43]  A. Iafrate,et al.  Mechanisms of Acquired Crizotinib Resistance in ALK-Rearranged Lung Cancers , 2012, Science Translational Medicine.

[44]  R. George,et al.  Emerging importance of ALK in neuroblastoma. , 2011, Seminars in cancer biology.

[45]  P. Włodarski,et al.  Inhibition of ALK enzymatic activity in T-cell lymphoma cells induces apoptosis and suppresses proliferation and STAT3 phosphorylation independently of Jak3 , 2005, Laboratory Investigation.

[46]  John P Leonard,et al.  Brentuximab vedotin (SGN-35) for relapsed CD30-positive lymphomas. , 2010, The New England journal of medicine.

[47]  Frank Speleman,et al.  Meta-analysis of Neuroblastomas Reveals a Skewed ALK Mutation Spectrum in Tumors with MYCN Amplification , 2010, Clinical Cancer Research.

[48]  S. Ogawa,et al.  Oncogenic mutations of ALK in neuroblastoma , 2011, Cancer science.

[49]  Yuki Togashi,et al.  EML4-ALK Fusion Is Linked to Histological Characteristics in a Subset of Lung Cancers , 2008, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[50]  S. Ogawa,et al.  Oncogenic mutations of ALK kinase in neuroblastoma , 2008, Nature.

[51]  M. Cilli,et al.  Neuroblastoma-targeted nanoparticles entrapping siRNA specifically knockdown ALK. , 2011, Molecular therapy : the journal of the American Society of Gene Therapy.

[52]  R. Gascoyne,et al.  Genomic profiling reveals different genetic aberrations in systemic ALK‐positive and ALK‐negative anaplastic large cell lymphomas , 2008, British journal of haematology.

[53]  Beatriz Bellosillo,et al.  Diversity of genomic breakpoints in TFG-ALK translocations in anaplastic large cell lymphomas: identification of a new TFG-ALK(XL) chimeric gene with transforming activity. , 2002, The American journal of pathology.

[54]  P. Jänne,et al.  The biology and treatment of EML4-ALK non-small cell lung cancer. , 2010, European journal of cancer.

[55]  G. Tonini,et al.  Mutation-independent anaplastic lymphoma kinase overexpression in poor prognosis neuroblastoma patients. , 2009, Cancer research.

[56]  Gudrun Schleiermacher,et al.  Somatic and germline activating mutations of the ALK kinase receptor in neuroblastoma , 2008, Nature.

[57]  S. Mori,et al.  Anaplastic large cell lymphomas expressing the novel chimeric protein p80NPM/ALK: a distinct clinicopathologic entity. , 1995, Leukemia.

[58]  V. Tin,et al.  A novel KIF5B‐ALK variant in nonsmall cell lung cancer , 2011, Cancer.

[59]  E. Rappaport,et al.  Stratification of patients with neuroblastoma for targeted ALK inhibitor therapy. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[60]  A. Rosenwald,et al.  Treatment and prognosis of mature T-cell and NK-cell lymphoma: an analysis of patients with T-cell lymphoma treated in studies of the German High-Grade Non-Hodgkin Lymphoma Study Group. , 2010, Blood.

[61]  H. Sugimura,et al.  EML4-ALK fusion transcripts, but no NPM-, TPM3-, CLTC-, ATIC-, or TFG-ALK fusion transcripts, in non-small cell lung carcinomas. , 2008, Lung cancer.

[62]  A. Yoshizawa,et al.  Clinicopathologic Features of Non-Small-Cell Lung Cancer with EML4–ALK Fusion Gene , 2010, Annals of Surgical Oncology.

[63]  Y. Ishikawa,et al.  KIF5B-ALK, a Novel Fusion Oncokinase Identified by an Immunohistochemistry-based Diagnostic System for ALK-positive Lung Cancer , 2009, Clinical Cancer Research.

[64]  Mitchell R. Smith,et al.  Brentuximab vedotin in anaplastic large cell lymphoma , 2012, Expert opinion on biological therapy.

[65]  R. Doebele,et al.  Rapid‐onset hypogonadism secondary to crizotinib use in men with metastatic nonsmall cell lung cancer , 2012, Cancer.

[66]  M. Wasik,et al.  STAT3 induces transcription of the DNA methyltransferase 1 gene (DNMT1) in malignant T lymphocytes. , 2006, Blood.

[67]  T. Utsunomiya,et al.  EML4–ALK fusion transcript is not found in gastrointestinal and breast cancers , 2008, British Journal of Cancer.

[68]  M. Xing,et al.  Anaplastic thyroid cancers harbor novel oncogenic mutations of the ALK gene. , 2011, Cancer research.

[69]  P. Gaulard,et al.  Gene-expression profiling of systemic anaplastic large-cell lymphoma reveals differences based on ALK status and two distinct morphologic ALK+ subtypes. , 2007, Blood.

[70]  Y. Ishikawa,et al.  A mouse model for EML4-ALK-positive lung cancer , 2008, Proceedings of the National Academy of Sciences.

[71]  H. Satoh,et al.  Hyperphosphorylation of a novel 80 kDa protein-tyrosine kinase similar to Ltk in a human Ki-1 lymphoma cell line, AMS3. , 1994, Oncogene.

[72]  M. Wasik,et al.  STAT3- and DNA methyltransferase 1-mediated epigenetic silencing of SHP-1 tyrosine phosphatase tumor suppressor gene in malignant T lymphocytes. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[73]  R. Sakai,et al.  Activation of anaplastic lymphoma kinase is responsible for hyperphosphorylation of ShcC in neuroblastoma cell lines , 2002, Oncogene.

[74]  Huaqing Zhao,et al.  Differential Inhibitor Sensitivity of Anaplastic Lymphoma Kinase Variants Found in Neuroblastoma , 2011, Science Translational Medicine.

[75]  D. Wen,et al.  Identification of Anaplastic Lymphoma Kinase as a Receptor for the Growth Factor Pleiotrophin* , 2001, The Journal of Biological Chemistry.

[76]  D. Weisenburger,et al.  International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[77]  Lin Huan,et al.  Screening for Epidermal Growth Factor Receptor Mutations in Lung Cancer , 2010 .

[78]  Tatiana G. Kutateladze,et al.  Mechanisms of Resistance to Crizotinib in Patients with ALK Gene Rearranged Non–Small Cell Lung Cancer , 2012, Clinical Cancer Research.

[79]  A. Tsiatis,et al.  Cytogenetic features of human neuroblastomas and cell lines. , 1981, Cancer research.

[80]  Jeffrey W. Clark,et al.  Effect of crizotinib on overall survival in patients with advanced non-small-cell lung cancer harbouring ALK gene rearrangement: a retrospective analysis. , 2011, The Lancet. Oncology.

[81]  P. Brousset,et al.  A new subtype of large B-cell lymphoma expressing the ALK kinase and lacking the 2; 5 translocation. , 1997, Blood.

[82]  Glen Spraggon,et al.  Crystal structure of the ALK (anaplastic lymphoma kinase) catalytic domain. , 2010, The Biochemical journal.

[83]  E. Campo,et al.  EML4-ALK rearrangement in non-small cell lung cancer and non-tumor lung tissues. , 2009, The American journal of pathology.

[84]  A. Rosenwald,et al.  Differential gene expression in anaplastic lymphoma kinase-positive and anaplastic lymphoma kinase-negative anaplastic large cell lymphomas. , 2005, Human pathology.

[85]  Jeffrey W. Clark,et al.  Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. , 2010, The New England journal of medicine.

[86]  John M. Maris,et al.  Identification of ALK as a major familial neuroblastoma predisposition gene , 2008, Nature.

[87]  L. Tanoue,et al.  Anaplastic Lymphoma Kinase Inhibition in Non–Small-Cell Lung Cancer , 2012 .

[88]  H. Sather,et al.  Association of multiple copies of the N-myc oncogene with rapid progression of neuroblastomas. , 1985, The New England journal of medicine.

[89]  M. Wasik,et al.  Anaplastic lymphoma kinase (ALK)-induced malignancies: novel mechanisms of cell transformation and potential therapeutic approaches. , 2009, Seminars in oncology.

[90]  R. Doebele,et al.  Treating ALK-positive lung cancer—early successes and future challenges , 2012, Nature Reviews Clinical Oncology.

[91]  T. Arakawa,et al.  Molecular characterization of ALK, a receptor tyrosine kinase expressed specifically in the nervous system , 1997, Oncogene.

[92]  H. Satoh,et al.  Anaplastic large cell lymphomas expressing the novel chimeric protein p80NPM/ALK: a distinct clinicopathologic entity. , 1995, Blood.

[93]  A. Iafrate,et al.  Impact of crizotinib on survival in patients with advanced, ALK-positive NSCLC compared with historical controls. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[94]  S. Navani,et al.  The human protein atlas , 2011 .

[95]  R. Salgia,et al.  MET pathway as a therapeutic target. , 2009, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[96]  A. Sihoe,et al.  The EML4‐ALK fusion gene is involved in various histologic types of lung cancers from nonsmokers with wild‐type EGFR and KRAS , 2009, Cancer.

[97]  M. Werner,et al.  Pathobiology of NPM-ALK and variant fusion genes in anaplastic large cell lymphoma and other lymphomas , 2000, Leukemia.

[98]  William Pao,et al.  ALK Mutations Conferring Differential Resistance to Structurally Diverse ALK Inhibitors , 2011, Clinical Cancer Research.

[99]  D. Levy,et al.  Anaplastic lymphoma kinase (ALK) activates Stat3 and protects hematopoietic cells from cell death , 2002, Oncogene.

[100]  William Pao,et al.  Escaping ALK Inhibition: Mechanisms of and Strategies to Overcome Resistance , 2012, Science Translational Medicine.

[101]  P. Marynen,et al.  ALK activation by the CLTC-ALK fusion is a recurrent event in large B-cell lymphoma. , 2003, Blood.