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Common gene fusion of the  ALK  gene is fusion of the  ALK  tyrosine kinase area and the 5’end of  EML4 . Seventeen  EML4‐ALK  fusion variants have been reported. Herein, we report a novel  EML4‐ALK  variant detected by next‐generation sequencing in a 36‐year‐old female lung adenocarcinoma patient who experienced disease progression after six months of alectinib treatment. Second generation sequencing revealed an  EML4‐ALK  fusion variant in which intron 19 of  EML4  was fused to exon 20 of  ALK . This is the first case of  EML4‐ALK  (E19: A20) fusion to be reported. Alectinib may show unsatisfactory therapeutic effects for this kind of  ALK  fusion.

Alectinib treatment response in lung adenocarcinoma patient with novel EML4‐ALK variant