Case Report: Adjuvant Crizotinib Therapy Exerted Favorable Survival Benefit in a Resectable Stage IIIA NSCLC Patient With Novel LDLR–ROS1 Fusion

An-Guo Chen,Ming-Zhe Xiao,Dong-Sheng Chen,Si Li,Le-Le Zhao

doi:10.3389/fonc.2022.837219

Abstract

Novel adjuvant strategies are needed to optimize outcomes after complete surgical resection in patients with early-stage non-small-cell lung cancer (NSCLC). The adjuvant treatment of ROS Proto-Oncogene 1 (ROS1) fusion-positive resected NSCLC is challenging because there is no curative confirmed randomized controlled trial. Next-generation sequencing (NGS) and immunohistochemistry (IHC) staining were performed on the biopsy sample. In this case, we identified a novel LDLR–ROS1 fusion in a resectable stage IIIA NSCLC patient. The patient received crizotinib as adjuvant treatment and achieved recurrence-free survival (RFS) for 29 months, without significant symptoms of toxicity. In this case, we report a novel LDLR–ROS1 fusion responding to crizotinib in a patient with lung adenocarcinoma, supporting the use of adjuvant treatment with the ROS1 inhibitor exerting clinical survival benefit in ROS1 fusion-positive resected NSCLC.

Highlights

Novel adjuvant strategies are needed to optimize outcomes after complete surgical resection in patients with early-stage non-small-cell lung cancer (NSCLC)
The disease was diagnosed as a stage IIIA lung adenocarcinoma with hilar node metastasis (T3N1M0, according to AJCC 8th edition)
The adjuvant treatment of ROS Proto-Oncogene 1 (ROS1) fusion-positive resected NSCLC is challenging because no confirmed randomized controlled trial has been reported

Summary

INTRODUCTION

Novel adjuvant strategies are needed to optimize outcomes after complete surgical resection in patients with early-stage non-small-cell lung cancer (NSCLC). The ADAURA trial and the IMpower trial have demonstrated significant clinical benefit in patients with resectable NSCLC who received targeted [1] and immune adjuvant therapy [2], respectively. Crizotinib in LDLR–ROS1 Fusion reported that the use of crizotinib, a ROS1 inhibitor, exerted favorable survival benefit (exceeded 29 months) in a resectable stage IIIA NSCLC patient with novel LDLR–ROS1 fusion. Postoperative pathological examination revealed complete surgical resection (R0), tumor involvement in the chest wall, and metastases in the positive hilar lymph node (3/4, tumor cells were detected in 3 of the 4 examined hilar lymph nodes), and there were no metastases in the distal lymph nodes. Follow-up examinations were performed every 6 months after surgery, clinical and radiological follow-up showed no evidence of progression or recurrence, and the recurrence-free survival (RFS) had exceeded

DISCUSSION

Findings

ETHICS STATEMENT