A portfolio of immunotherapies to treat ALK+ cancers
Roberto Chiarle
Department of Pathology (Boston Children's Hospital)
Cancers driven by the oncogenic activation of the ALK gene include subsets of non-small cell lung cancer, lymphoma, neuroblastoma, melanoma, glioblastoma, thyroid cancer, stromal tumors and other hematologic malignancies and solid tumors. Typically, these cancers affect children or young adults in healthy conditions with a long expectancy of life. They are currently treated with ALK tyrosine kinase inhibitors (TKIs) either in first line or at relapse after other standard therapies. ALK TKIs reduce tumor burden dramatically, and often induce a prolonged state of minimal residual disease (MRD) resulting in several years of extended survival. Eventually, most ALK+ tumors become resistant to ALK TKIs by different mechanisms. Relapses occur in >90% of patients that are then left without efficacious therapies and face a dismal prognosis. This common pattern of evolution of ALK+ tumors, characterized by a prolonged state MRD before the fatal relapse, provides a window of opportunity to develop therapies that might be curative should ALK+ persister cells be fully eliminated.