■鉴于靶向治疗对具有致癌驱动因素的晚期非小细胞肺癌(NSCLC)患者的有希望的疗效,它在辅助甚至新辅助治疗中的使用正在增加。洛拉替尼是一种强效的脑穿透性第三代间变性淋巴瘤激酶(ALK)和c-ros癌基因1,受体酪氨酸激酶(ROS1)酪氨酸激酶抑制剂(TKIs),具有广泛的ALK突变覆盖率。目前,关于氯拉替尼作为新辅助治疗在存在ALK重排的局部晚期NSCLC中的疗效的证据有限.本病例报告的目的是描述在IIIA期ALK阳性NSCLC患者中,对新辅助氯拉替尼的病理完全缓解(pCR)的罕见病例。为新辅助靶向治疗提供证据。
■一名35岁男性经病理诊断为局部晚期IIIA期(cT2bN2M0)ALK阳性NSCLC。临床上,患者左下叶有肺结节,随着随访逐渐扩大,通过计算机断层扫描(CT)扫描最大的约为4.6cm×2.8cm,我们发现淋巴结(4L站,7和8)被转移侵袭。在每天100mg的氯拉替尼进行3个月的新辅助治疗后,他的CT扫描显示部分缓解(PR)。然后,该患者通过电视辅助胸腔镜手术(VATS)进行了纵隔淋巴结清扫术(MLD)和纵隔囊肿切除术。术后病理显示pCR。该患者继续接受氯拉替尼,并在10个月的随访中保持无病。
■在此,我们报道了新辅助氯拉替尼治疗IIIA期ALK阳性NSCLC患者pCR的病例。我们的发现强调了氯拉替尼作为可切除的ALK阳性NSCLC的新辅助治疗的潜力。
UNASSIGNED: Given the promising efficacy of targeted therapies in patients with advanced non-small cell lung cancer (NSCLC) harboring oncogenic drivers, its use in adjuvant and even neoadjuvant therapy is increasing.
Lorlatinib is a potent brain-penetrating third-generation anaplastic lymphoma kinase (ALK) and c-ros oncogene 1, receptor tyrosine kinase (ROS1) tyrosine kinase inhibitors (TKIs) with broad ALK mutation coverage. Currently, there is a limited evidence regarding the efficacy of
lorlatinib as neoadjuvant therapy in locally advanced NSCLC in the presence of ALK rearrangements. The aim of this case report is to describe a rare case of pathological complete response (pCR) to neoadjuvant
lorlatinib in a patient with stage IIIA ALK-positive NSCLC, providing evidence for neoadjuvant targeted therapy.
UNASSIGNED: A 35-year-old male was pathologically diagnosed with locally advanced stage IIIA (cT2bN2M0) ALK-positive NSCLC. Clinically, the patient had pulmonary nodules in the left inferior lobe, which were enlarged progressively with follow-up, with the largest measuring approximately 4.6 cm × 2.8 cm by computed tomography (CT) scan and we found that the lymph nodes (stations 4L, 7, and 8) were invaded by metastasis. Following a 3-month neoadjuvant treatment with
lorlatinib at 100 mg daily, his CT scan demonstrated a partial response (PR). This patient then underwent a left inferior lobectomy with mediastinal lymph node dissection (MLD) and mediastinal cyst resection via video-assisted thoracoscopic surgery (VATS). Postoperative pathology revealed a pCR. This patient continued to receive
lorlatinib and remained disease free at his 10-month follow-up.
UNASSIGNED: Herein we reported the case of a pCR in stage IIIA ALK-positive NSCLC patient treated with neoadjuvant lorlatinib. Our findings underscore the potential of lorlatinib as a neoadjuvant treatment for resectable ALK-positive NSCLC.