Tracking a CAD-ALK gene rearrangement in urine and blood of a colorectal cancer patient treated with an ALK inhibitor

G. Siravegna, A. Sartore-Bianchi, B. Mussolin, A. Cassingena, A. Amatu, L. Novara, M. Buscarino, G. Corti, G. Crisafulli, A. Bartolini, F. Tosi, M. Erlander, F. Di Nicolantonio, S. Siena, A. Bardelli

Research output: Contribution to journalArticlepeer-review


Background: Monitoring response and resistance to kinase inhibitors is essential to precision cancer medicine, and is usually investigated by molecular profiling of a tissue biopsy obtained at progression. However, tumor heterogeneity and tissue sampling bias limit the effectiveness of this strategy. In addition, tissue biopsies are not always feasible and are associated with risks due to the invasiveness of the procedure. To overcome these limitations, blood-based liquid biopsy analysis has proven effective to non-invasively follow tumor clonal evolution. Patients and methods: We exploited urine cell-free, trans-renal DNA (tr-DNA) and matched plasma circulating tumor DNA (ctDNA) to monitor a metastatic colorectal cancer patient carrying a CAD-ALK translocation during treatment with an ALK inhibitor. Results: Using a custom next generation sequencing panel we identified the genomic CAD-ALK rearrangement and a TP53 mutation in plasma ctDNA. Sensitive assays were developed to detect both alterations in urine tr-DNA. The dynamics of the CAD-ALK rearrangement in plasma and urine were concordant and paralleled the patient's clinical course. Detection of the CADALK gene fusion in urine tr-DNA anticipated radiological confirmation of disease progression. Analysis of plasma ctDNA identified ALK kinase mutations that emerged during treatment with the ALK inhibitor entrectinib. Conclusion: We find that urine-based genetic testing allows tracing of tumor-specific oncogenic rearrangements. This strategy could be effectively applied to non-invasively monitor tumor evolution during therapy. The same approach could be exploited to monitor minimal residual disease after surgery with curative intent in patients whose tumors carry gene fusions. The latter could be implemented without the need of patient hospitalization since urine tr-DNA can be self-collected, is stable over time and can be shipped at specified time-points to central labs for testing.

Original languageEnglish
Article numbermdx095
Pages (from-to)1302-1308
Number of pages7
JournalAnnals of Oncology
Issue number6
Publication statusPublished - Jun 1 2017


  • ALK inhibitor
  • ALK translocation
  • Circulating DNA
  • Colorectal cancer
  • Liquid biopsy
  • Trans-renal DNA

ASJC Scopus subject areas

  • Hematology
  • Oncology


Dive into the research topics of 'Tracking a CAD-ALK gene rearrangement in urine and blood of a colorectal cancer patient treated with an ALK inhibitor'. Together they form a unique fingerprint.

Cite this