Which Tyrosine Kinase Inhibitor Must We Apply Before? A Case Report of Crizotinib-resistant Patient with Concomitant EGFR and EML4-ALK Gene Mutations

ABSTRACT The concomitant epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocations in lung adenocancers are very rare scenarios. Until now, 42 cases described in the literature have all been treated by different drugs. There is no overall consensus regarding the treatment for this adenocarcinoma subgroup. We report here a case of lung adenocarcinoma with concomitant EGFR mutation in exon 21 (L858R) and ALK rearrangement in primary tumour, EGFR mutation in exon 21 (L858R) and no ALK rearrangement in its synchronous metastasis. We treated this patient with crizotinib as the second-line therapy (after the first line docetaxel-cisplatin chemotherapy), but no response was obtained. The therapeutic choice for the lung adenocancer patients with concomitant EGFR mutation and ALK rearrangement is unclear. Examination of c-ros oncogene 1 mutation can be used as an indicator in the prediction of the crizotinib treatment success. The ALK mutation may not responsible for the resistance to EGFR-tyrosine kinase inhibitors (TKI), and EGFR-TKI can be initiated to EGFR and ALK dual mutant patients as the first treatment.

Harvesting impact on herbaceous understory, forest floor and top soil properties on skid road in a beech (Fagus orientalis Lipsky) stand.

In this study the impact of production work on the skid roads that have been carried out for many years by manpower animal power or machinery in a beech (Fagus orientalis Lipsky) stand have been examined. For this purpose, herbaceous understory, forest floor and soil samples were collected from the undisturbed area and the skid road. Weight per unit area (kg ha(-1)), organic matter ratio and moisture of forest floor and herbaceous understory were measured in undisturbed area and the skid road. Soil characteristics were examined at two different depths (0-5 cm and 5-10 cm). Percentages of sand, silt and clay electrical conductivity, weight of fine soil (<2 mm), soil fraction (>2 mm), root mass, organic carbon, moisture equivalent, total porosity, bulk density, moisture, compaction and pH values in the soil were determined. It has been determined that the amount of herbaceous understory and forest floor on the skid road decreased considerably compared to those of the undisturbed area. Parallel to this, the amount of organic matter in the herbaceous understory and the forest floor on the skid road decreased as well. It has been concluded that there are crucial differences between the values of compaction, bulk density fine soil weight, total porosity and moisture equivalent of the soil samples collected from both the skid road and the undisturbed area at both depth levels, as a result of compaction of the soil caused by harvesting works.