Feasibility and Safety of Neoadjuvant Alectinib in Pulmonary Invasive Mucinous Adenocarcinoma with ALK Rearrangement: Case Report and Literature Review

Abstract

Background: Pulmonary invasive mucinous adenocarcinoma (IMA) is a rare variant of lung adenocarcinoma that rarely shows anaplastic lymphoma kinase (ALK) rearrangement. Alectinib (tyrosine kinase inhibitors) has been listed as category 1 recommendations for advanced ALK + NSCLC first-line therapy due to low toxicity and excellent efficacy, and its median progression-free survival is 34.8 months. Here, we report a case of a patient with ALK-rearranged lung IMA who showed favorable results to neoadjuvant alectinib. Case: A 67-year-old man with no history of smoking was diagnosed with clinical stage as IIIB invasive mucinous adenocarcinoma based on clinical symptoms, chest CT and pathological findings. The anaplastic lymphoma kinase (ALK) fusion status was assessed by realtime PCR. After acquiring informed consent from the patient, we offered neoadjuvant alectinib at a dosage of 150 mg twice per day for three cycles (84 days), all lesions were undetectable on chest CT. Later, a thoracoscopic left lobectomy was performed. The postoperative pathological showed that a small amount of tumor cells remained, and the TNM stage was downstaged as T1aN0M0 IA. Conclusion: To our knowledge, this is the first case discussing the treatment of ALKrearranged IMA of the lung with neoadjuvant alectinib. Alectinib is an effective ALK inhibitor, and in cases of lung adenocarcinoma with ALK rearrangement, alectinib treatment is a reasonable and priority option. Neoadjuvant alectinib may be clinically feasible and well tolerated in locally advanced NSCLC.

Neoadjuvant Savolitinib targeted therapy stage IIIA-N2 primary lung adenocarcinoma harboring MET Exon 14 skipping mutation: A case report

“…Previous clinical trials have already verified the availability of EGFR and ALK inhibitors neoadjuvant targeted therapy in the disease control and pathological downstaging for early-stage NSCLC patients harboring the corresponding mutation, and some case reports also observed that target therapy provided effective radiologic and pathologic response in ALK , RET and ROS1 -positive resectable NSCLC patients ( 3 , 6 , 13 – 15 ). MET ex14m is an independent oncogenic driver occurring in 2.8% of resected stage I-III NSCLC patients ( 16 ).…”

“…Immunohistochemistry outcomes were presented as: HE (A), TTF-1 (+) (B), NapsinA (+) (C), CK7 (+) (D), CK5/6 (-), CK (pan) (+), and Ki-67 (+, about 50%). some case reports also observed that target therapy provided effective radiologic and pathologic response in ALK, RET and ROS1-positive resectable NSCLC patients (3,6,(13)(14)(15). METex14m is an independent oncogenic driver occurring in 2.8% of resected stage I-III NSCLC patients (16).…”

Neoadjuvant alectinib in locally advanced lung adenocarcinoma with anaplastic lymphoma kinase rearrangement: case series and literature review

“…neoadjuvant treatment did not experience treatment-related adverse effects but achieved an MPR. Taking the medical records of these two cases together with previous reports [4][5][6], neoadjuvant alectinib maybe clinically feasible.…”

Dramatic response to neoadjuvant savolitinib in marginally resectable lung adenocarcinoma with MET exon 14 skipping mutation: A case report and literature review

“…Ten patients (91%) had R0 resection, including two cases of pCR ( 23 ). Furthermore, cases of successful neoadjuvant targeted therapy for ROS1, RET, or ALK rearrangement were reported ( 25 – 28 ). The prospective phase II ALNEO and NAUTIKA1 studies on neoadjuvant alectinib therapy finished enrolment, and preliminary results were reported ( 29 , 30 ).…”