# Identification of targetable ALK rearrangements in pancreatic ductal adenocarcinoma

Source: https://onco.cc/key-papers/paper-singhi-alk-rearrangements-pancreatic-jnccn-2017/  
OnCo record `paper-singhi-alk-rearrangements-pancreatic-jnccn-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Screening 3,170 pancreatic cancers found five with an ALK gene fusion, all in patients under 50 and none with a KRAS mutation, and three of four treated with ALK inhibitors benefited.

## Summary

Comprehensive genomic profiling of 3,170 pancreatic ductal adenocarcinomas identified 5 cases (0.16%) with an ALK fusion: exon 6 EML4-exon 20 ALK (3), exon 13 EML4-exon 20 ALK (1) and exon 3 STRN-exon 20 ALK (1). Activating KRAS mutations were absent in all 5, who were under 50; among patients under 50, ALK translocations were 1.3% of cancers. Four of 5 were treated with an ALK inhibitor and 3 showed stable disease, radiographic response and/or CA 19-9 normalisation.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Journal: Journal of the National Comprehensive Cancer Network
- Year: 2017
- DOI: 10.6004/jnccn.2017.0058
- Authors: Singhi AD, Ali SM, Lacy J, et al.
- Findings: ALK fusions in 5 of 3,170 (0.16%), 1.3% of patients under 50, all KRAS wild-type.; 3 of 4 treated with ALK inhibitors benefited.
- What it means: ALK is the reason young, KRAS wild-type patients should have fusion testing even though the overall rate is one in six hundred.
- Caveats: Five cases; response data are case-level.; Commercial referral cohort.

## Sources

- Singhi et al., JNCCN 2017: ALK rearrangements in 5 of 3,170 pancreatic ductal adenocarcinomas: https://doi.org/10.6004/jnccn.2017.0058
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28476735/

## Connected records

- biomarkers: [ALK fusion (ALK-positive)](https://onco.cc/biomarkers/alk-fusion/)
- cancers: [KRAS wild-type pancreatic ductal adenocarcinoma](https://onco.cc/cancers/kras-wild-type-pdac/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- targets: [ALK](https://onco.cc/targets/alk/)
- drugs: [Alectinib](https://onco.cc/drugs/alectinib/), [Crizotinib](https://onco.cc/drugs/crizotinib/)
- institutions: [UPMC Hillman Cancer Center](https://onco.cc/institutions/upmc-hillman/)
- pathways: [Receptor tyrosine kinase activation](https://onco.cc/pathways/rtk-activation/)

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