PDF(Pubmed)
Abstract：
The application of adjuvant treatment has significantly enhanced the survival of patients with resectable non-small cell lung cancer (NSCLC) carrying driver gene mutations. However, adjuvant-targeted therapy remains controversial for some NSCLC patients carrying rare gene mutations such as RET, as there is currently a lack of confirmed randomized controlled trials demonstrating efficacy. In this report, we describe the case of a 58-year-old man with stage IIIA NSCLC who underwent complete lobectomy with selective lymph node dissection. Postoperative next-generation sequencing revealed that the patient harbored a rare KIF13A-RET fusion. The patient elected to receive adjuvant treatment with pralsetinib monotherapy and underwent serial circulating tumor DNA (ctDNA) monitoring after surgery. During follow-up, despite experiencing dose reduction and irregular medication adherence, the patient still achieved a satisfactory disease-free survival (DFS) of 27 months. Furthermore, ctDNA predicted tumor recurrence 4 months earlier than imaging techniques. The addition of bevacizumab to the original regimen upon recurrence continued to be beneficial. Pralsetinib demonstrated promising efficacy as adjuvant therapy, while ctDNA analysis offered a valuable tool for early detection of tumor recurrence. By leveraging targeted therapies and innovative monitoring techniques, we aim to improve outcomes and quality of life for NSCLC patients in the future.
摘要：
辅助治疗的应用显著提高了携带驱动基因突变的可切除非小细胞肺癌(NSCLC)患者的生存率。然而,一些携带RET等罕见基因突变的非小细胞肺癌患者的辅助靶向治疗仍存在争议,因为目前缺乏证实疗效的随机对照试验.在这份报告中,我们描述了1例58岁的IIIA期NSCLC患者接受了选择性淋巴结清扫术的全肺叶切除术.术后下一代测序显示患者存在罕见的KIF13A-RET融合。患者选择接受普雷替尼单一疗法的辅助治疗，并在手术后接受连续循环肿瘤DNA（ctDNA）监测。随访期间,尽管经历了剂量减少和不规则的药物依从性，患者仍实现了令人满意的27个月无病生存期(DFS).此外，ctDNA预测肿瘤复发比影像学技术早4个月。在复发后将贝伐单抗添加到原始方案中继续是有益的。Pralsetinib显示出有希望的疗效作为辅助治疗，而ctDNA分析为早期检测肿瘤复发提供了有价值的工具。通过利用有针对性的治疗和创新的监测技术，我们的目标是在未来改善NSCLC患者的预后和生活质量.
