Pediatric patient with peritoneal mesothelioma harboring ALK rearrangement

Abstract

Malignant mesothelioma is a rare disease that typically occurs in older patients with prolonged exposure to asbestos. The majority of mesothelioma occurs in the pleura. Less frequently, patients will develop peritoneal mesothelioma without pleural involvement. Within this subset of patients, therapeutically targetable somatic mutations are being identified. Here we describe a 17-year old female with metastatic peritoneal mesothelioma without prior asbestos history. After disease progression on cytotoxic chemotherapy, the small molecule crizotinib, an Anaplastic Lymphoma Kinase (ALK) inhibitor, was administered based on detection of somatic STRN-ALK fusion mutation. Rapid symptomatic improvement and tumor response was followed by surgical eradication of disease. The patient remains disease-free over 12 months later. This case is an example of a rare subset of young females who may develop peritoneal mesothelioma, without pleural involvement, secondary to ALK translocations. This report demonstrates the growing knowledge of this rare subgroup and the need for further investigation into ALK translocation as a driver for peritoneal mesothelioma development, progression, and evaluation of ALK inhibitors in malignant mesothelioma.

Keywords

• Peritoneal mesothelioma
• Translocation
• Personalized medicine
• ALK mutation