Left total pneumonectomy performed after alectinib treatment for anaplastic lymphoma kinase-positive lung adenocarcinoma: a case report.

BACKGROUND: Anaplastic lymphoma kinase (ALK) rearrangement generates an oncogenic ALK tyrosine kinase that activates numerous downstream signaling pathways, leading to increased cell proliferation and survival. About 5% of non-small cell lung cancer (NSCLC) patients are being diagnosed with tumor harboring ALK-positive. ALK rearrangement is an important molecular target for the treatment of NSCLC, and alectinib is a potent and highly selective second-generation ALK inhibitor. Alectinib as a neoadjuvant therapy has been reported in previous studies. However, cases of patients undergoing left total pulmonary resection after neoadjuvant therapy are rare.

CASE DESCRIPTION: In this report, a 52-year-old Asian woman's chest computed tomography (CT) showed mass shadows in the left lung. Echinoderm microtubule-associated protein-like 4-ALK (EML4-ALK) fusion variant was detected by next-generation sequencing. We administered the targeted drug alectinib at 600 mg twice daily for two and a half months. Positron emission tomography (PET)-CT examination showed that the left lung mass and lymph nodes were significantly reduced. The tumor node metastasis (TNM) stage was reduced from cT4N2M0, IIIb to ycT2aN0M0, IB. Then she underwent thoracoscopic transthoracotomy of the left total lung. Oral alectinib therapy was continued after surgery, and the follow-up duration was one year.

CONCLUSIONS: This case indicates that alectinib is feasible and has a good safety profile as a neoadjuvant therapy for ALK-positive NSCLC. But further research is needed to determine how long the treatment should last for patients to get the most benefit. There is also the problem of pulmonary fibrosis in the process of alectinib neoadjuvant therapy, which needs to be solved urgently.