Pathological complete response to neoadjuvant alectinib in unresectable anaplastic lymphoma kinase positive non-small cell lung cancer: A case report

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.