Pathological Complete Response in Locally Advanced ALK Fusion Gene-Positive Lung Adenocarcinoma following Salvage...

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.

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.

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.