医学
阿列克替尼
新辅助治疗
肺癌
肿瘤科
腺癌
放射治疗
内科学
化疗
癌症
间变性淋巴瘤激酶
乳腺癌
恶性胸腔积液
作者
Daniel Sentana‐Lledo,Hollis Viray,Andrew J. Piper-Vallillo,Page Widick,Deepa Rangachari,Jennifer Wilson,Sidhu P. Gangadharan,Joseph A. Aronovitz,Stuart M. Berman,Paul A. VanderLaan,Daniel Benevides da Costa
出处
期刊:Lung Cancer
[Elsevier]
日期:2022-10-01
卷期号:172: 124-126
被引量:4
标识
DOI:10.1016/j.lungcan.2022.08.014
摘要
Neoadjuvant therapy prior to surgical resection for locally advanced lung cancer has evolved to incorporate systemic cytotoxic chemotherapy +/- immunotherapy +/- radiotherapy. The role of neoadjuvant precision therapies remains understudied.We report cases with major and complete pathologic responses to off-label neoadjuvant alectinib.A case with stage IIIA (cT1b cN2 cM0) EML4-ALK variant 3a/b lung adenocarcinoma received 6 weeks of alectinib followed by R0 left upper lobectomy with complete pathological response (ypT0 ypN0). Another case with stage IIIA (cT3 cN2 cM0) EML4-ALK variant 2 received 12 weeks of alectinib followed by R0 right middle lobectomy with a major pathologic response (ypT1a ypN0) but systemic recurrence 12 months post-operatively.Ongoing clinical trials are evaluating the role of both neoadjuvant and adjuvant ALK-directed therapy. Our cases support the completion of ongoing trials (ALINA: NCT03456076 and ALNEO: NCT05015010), and highlight the ability of second generation ALK inhibitors to induce major and complete pathologic responses in the neoadjuvant setting plus the likely role of long-term adjuvant kinase inhibitor therapy to prevent radiographic/clinical recurrence.
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