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Neoadjuvant Selpercatinib for Stage IIIA Primary Pulmonary Adenocarcinoma With RET Fusion: A Case Report
Zihan Cui1,2, Yizhuo Hu1,2, Jun Zhao1,2
1Department of Thoracic Surgery The First Affiliated Hospital of Soochow University, Medical College of Soochow University Suzhou China.
Abstract:
Selpercatinib represents the first targeted therapeutic agent approved for RET fusion-positive unresectable non-small cell lung cancers. This case report describes a patient with stage IIIA (cT2aN2M0) RET fusion-mutated adenocarcinoma of the left upper lobe. Following 9 months of selpercatinib therapy, the patient achieved clinical downstaging and subsequently underwent curative resection. Postoperative pathologic staging was IIA (ypT1bN1M0). Adjuvant therapy with selpercatinib was continued postoperatively. The patient remained recurrence-free on continued follow-up with 17 months since diagnosis and 8 months since surgery.
Insights
Selpercatinib, a targeted therapy for RET fusion-positive lung cancer, enabled clinical downstaging for curative surgery in a stage IIIA patient. The patient remained recurrence-free after treatment and surgery.
Area of Science:
- Oncology
- Molecular Diagnostics
- Thoracic Surgery
Background:
- Non-small cell lung cancer (NSCLC) with RET fusions represents a distinct molecular subtype.
- Targeted therapies are revolutionizing NSCLC treatment paradigms.
- Selpercatinib is an approved targeted therapeutic for RET fusion-positive NSCLC.
Purpose of the Study:
- To report a case of successful treatment and curative resection of RET fusion-positive lung cancer using selpercatinib.
- To illustrate the potential of targeted therapy in achieving clinical downstaging for surgical resection.
Main Methods:
- A patient with stage IIIA RET fusion-mutated lung adenocarcinoma received selpercatinib.
- Clinical response was assessed, leading to surgical intervention.
- Postoperative pathological staging and adjuvant therapy were documented.
Main Results:
- The patient achieved clinical downstaging after 9 months of selpercatinib therapy.
- Curative resection was performed, with postoperative staging of IIA (ypT1bN1M0).
- The patient remained recurrence-free at 17 months post-diagnosis and 8 months post-surgery with adjuvant selpercatinib.
Conclusions:
- Selpercatinib can facilitate downstaging of advanced RET fusion-positive NSCLC, enabling curative-intent surgery.
- Combination therapy with selpercatinib and surgery may offer a promising approach for select NSCLC patients.
- Long-term recurrence-free survival is achievable with targeted therapy and surgical management.
