Wang LM, Zhao P, Sun XQ, Yan F, Guo Q. Pathological complete response to neoadjuvant alectinib in unresectable anaplastic lymphoma kinase positive non-small cell lung cancer: A case report. World J Clin Cases 2023; 11(22): 5322-5328 [PMID: 37621597 DOI: 10.12998/wjcc.v11.i22.5322]
Corresponding Author of This Article
Qian Guo, MD, Doctor, Department of Medical Oncology, The First People’s Hospital of Hangzhou Lin’an District, No. 548 Yijin Street, Jincheng Street, Lin’an District, Hangzhou 311300, Zhejiang Province, China. gqwy2007@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Lu-Ming Wang, Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310002, Zhejiang Province, China
Peng Zhao, Xu-Qi Sun, Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310002, Zhejiang Province, China
Feng Yan, Qian Guo, Department of Medical Oncology, The First People’s Hospital of Hangzhou Lin’an District, Hangzhou 311300, Zhejiang Province, China
Author contributions: Wang LM and Zhao P contributed to manuscript writing and editing, and data collection; Sun XQ and Yan F contributed to data analysis; Guo Q contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript has been prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qian Guo, MD, Doctor, Department of Medical Oncology, The First People’s Hospital of Hangzhou Lin’an District, No. 548 Yijin Street, Jincheng Street, Lin’an District, Hangzhou 311300, Zhejiang Province, China. gqwy2007@163.com
Received: March 20, 2023 Peer-review started: March 20, 2023 First decision: June 15, 2023 Revised: June 28, 2023 Accepted: July 7, 2023 Article in press: July 7, 2023 Published online: August 6, 2023
Abstract
BACKGROUND
The development of anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitors (TKIs) has remarkably improved the prognosis of patients with ALK-positive advanced non-small cell lung cancer (NSCLC). Alectinib, the second-generation ALK-TKI, has been approved as first-line treatment for advanced or metastatic NSCLC patients with ALK rearrangement. Neoadjuvant therapy can achieve tumor downstaging and eradicate occult lesions in patients with potentially resectable disease. Whether neoadjuvant alectinib can be a conversion therapy in ALK-positive advanced NSCLC patients remains unclear.
CASE SUMMARY
A 41-year-old man was pathologically diagnosed with locally advanced ALK-positive stage IIIB NSCLC. Alectinib was prescribed to induce tumor downstaging and facilitate the subsequent surgical resection. The tumor was successfully downstaged and pathological complete response was achieved. Left upper lobectomy with mediastinal lymphadenectomy was performed after tumor downstaging. The patient has continued to receive alectinib as adjuvant therapy during postoperative follow-up with a recurrence-free survival of 29 mo as of writing this report.
CONCLUSION
This case sheds light on the feasibility and safety of alectinib as a neoadjuvant treatment for stage IIIB NSCLC patients with ALK rearrangement. Its efficacy needs to be validated in prospective clinical trials.
Core Tip: Whether neoadjuvant alectinib can serve as a conversion therapy in patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small-cell lung cancer (NSCLC) remains unclear. We report the first case of ALK-positive stage IIIB NSCLC in which a pathological complete response was achieved after neoadjuvant alectinib therapy. Subsequently, left upper lobectomy with mediastinal lymphadenectomy was performed. Postoperatively, alectinib is being continued as adjuvant therapy with a recurrence-free survival of 29 mo as of date. This case report highlights the feasibility of alectinib as neoadjuvant therapy for unresectable ALK-positive locally advanced NSCLC.
