Abstract
BackgroundAlectinib is a highly selective tyrosine kinase inhibitor of anaplastic lymphoma kinase (ALK) and provided a significantly prolonged progression-free survival compared with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) harboring rearrangements of the ALK gene. Here, we present the first surgical case of ALK-rearranged lung adenocarcinoma with major pathological response in resected specimens after treatment with alectinib.Case presentationA 65-year-old female with clinical stage IIIA-N2 ALK-rearranged adenocarcinoma originating from the left lower lobe presented. Involvement of lower para-tracheal node was pathologically confirmed by endobronchial ultrasound-guided biopsy. Alectinib was prescribed, as the patient may not tolerate radiotherapy due to a mental illness. After 3 months’ treatment with alectinib, a remarkable radiological and metabolic response was achieved. The patient did not tolerate further continuation of alectinib treatment, and surgery was performed without any morbidity. Only < 10% tumor cells were viable in all resected specimens, indicating major pathological response to alectinib.ConclusionsSalvage surgery after alectinib treatment may be safe and effective for initially unresectable NSCLC harboring ALK-rearrangements.
Highlights
Alectinib is a highly selective tyrosine kinase inhibitor of anaplastic lymphoma kinase (ALK) and provided a significantly prolonged progression-free survival compared with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) harboring rearrangements of the ALK gene
Non-small cell lung cancer (NSCLC) with rearrangement of the anaplastic lymphoma kinase (ALK) gene is a distinct subtype of lung cancer
Crizotinib, the first approved tyrosine kinase inhibitor (TKI) of ALK, provided a significantly prolonged progression-free survival compared with chemotherapy in patients with advanced ALK-rearranged NSCLC [1]
Summary
Non-small cell lung cancer (NSCLC) with rearrangement of the anaplastic lymphoma kinase (ALK) gene is a distinct subtype of lung cancer. Crizotinib, the first approved tyrosine kinase inhibitor (TKI) of ALK, provided a significantly prolonged progression-free survival compared with chemotherapy in patients with advanced ALK-rearranged NSCLC [1]. We report the first case of ALK-rearranged lung adenocarcinoma with major pathological response in resected specimens after treatment with alectinib, which may provide a pathological rationale for its greater clinical efficacy. Case presentation A 65-year-old female with a mental illness (bipolar disorder) was referred to our institute for the treatment of ALK-rearranged lung adenocarcinoma originating from the left lower lobe. The patient did not tolerate further continuation of alectinib treatment, and surgery was performed. Pathological examination revealed that only < 10% tumor cells were viable in all resected specimens, indicating major pathological response to alectinib (Fig. 3). The patient refused any additional treatment and is alive without any tumor recurrence at 5 months after surgery
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