Case Report: Neoadjuvant and Adjuvant Crizotinib Targeted Therapy in Stage IIIA-N2 ALK-Positive Non-Small-Cell Lung Cancer

Xiao-Hong Xie; Ze-Jiang Zhan; Yin-Yin Qin; Ju-Hong Jiang; Wei-Qiang Yin; Rong-Hui Zheng; Shi-Yue Li; Cheng-Zhi Zhou

doi:10.3389/fonc.2021.655856

Case Report: Neoadjuvant and Adjuvant Crizotinib Targeted Therapy in Stage IIIA-N2 ALK-Positive Non-Small-Cell Lung Cancer

Front Oncol. 2021 Mar 17:11:655856. doi: 10.3389/fonc.2021.655856. eCollection 2021.

Authors

Xiao-Hong Xie^{1

2}, Ze-Jiang Zhan^{2

3}, Yin-Yin Qin^{1

2}, Ju-Hong Jiang^{2

4}, Wei-Qiang Yin^{2

5}, Rong-Hui Zheng^{2

3}, Shi-Yue Li^{1

2}, Cheng-Zhi Zhou^{1

2}

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.
² Guangzhou Medical University, Guangzhou, China.
³ Department of Radiation Oncology, The Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.
⁴ Department of Respiratory Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.
⁵ Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.

Abstract

The treatment of anaplastic lymphoma kinase (ALK)-positive locally advanced non-small-cell lung cancer (NSCLC) is challenging because there is no randomized controlled trial has been reported. The value of neoadjuvant and adjuvant targeted therapy remains unclear. Herein, we show that systemic treatment with ALK inhibitor crizotinib before surgery can provide the potential to cure the initially inoperable tumor. A 27-year-old man was diagnosed with a stage IIIAcT3N2M0 (7^thUICC/AJCC) upper left lung adenocarcinoma harboring EML4-ALK fusion gene. Clinically, the patient had a large primary lesion adjacent to the pericardium and regional lymph node metastasis at the ipsilateral mediastinum. Poor tumor response was observed after 3 cycles of chemotherapy (gemcitabine plus cisplatin), and upon multidisciplinary discussion, the patient was started with 250 mg crizotinib twice daily. Successive clinical examinations showed a progressive reduction of the lesions. After 2 months of therapy, the patient was downstaged to cT2aN2M0, then video-assisted thoracic surgery was performed and the final histopathological stage was ypT2aN2M0. The treatment with crizotinib (250 mg, qd) was continued more than 30 months post surgery and stopped until intracranial oligometastasis. The patient's overall survival (OS) time is 68 months at last follow-up. This case presented here supports the use of neoadjuvant and adjuvant treatment with ALK inhibitors in ALK positive locally advanced NSCLC.

Keywords: ALK inhibitor; adjuvant; locally advanced non-small-cell lung cancer; neoadjuvant; targeted therapy.

Publication types

Case Reports