Pathological Complete Response in Locally Advanced ALK Fusion Gene–Positive Lung Adenocarcinoma following Salvage Surgery: A Case Report and Literature Review
Abstract
ABSTRACT INTRODUCTION Alectinib, a 2nd-generation anaplastic lymphoma kinase–tyrosine kinase inhibitor (ALK-TKI), is an established 1st-line therapy for advanced ALK fusion gene–positive non–small cell lung cancer (NSCLC). However, the role of salvage surgery following alectinib for locally advanced disease remains uncertain. CASE PRESENTATION A 41-year-old woman was diagnosed in the postpartum period with Stage IIIA (cT1cN2M0) ALK fusion gene–positive lung adenocarcinoma. She received 1st-line alectinib, achieving a 55.3% reduction in tumor size over 11 months. Subsequent salvage surgery revealed a pathological complete response with no residual tumor cells. During postoperative follow-up off alectinib, recurrence was observed 20 months after surgery, with new brain and pulmonary metastases. Reintroduction of alectinib achieved renewed disease control, and the patient has remained progression-free for 23 months since restarting therapy. CONCLUSIONS This case highlights the potential role of salvage surgery following alectinib in locally advanced ALK fusion gene–positive NSCLC. Furthermore, it suggests that maintenance ALK-TKI therapy after salvage surgery might be associated with a reduced risk of recurrence. Further studies are warranted to optimize perioperative ALK-targeted strategies.
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