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Case Report: ALK rearranged locally advanced lung adenocarcinoma showing inconsistent radiographic findings and pathological responses during neoadjuvant alectinib therapy

Alectinib has been approved as first-line treatment for anaplastic lymphoma kinase (ALK)-positive non-small cell lung carcinoma. Oncologists are also exploring the possibility of applying alectinib in the perioperative period. Here, we present a patient with locally advanced lung adenocarcinoma asso...

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Autores principales: Cao, Peijun, Zhao, Qingchun, Li, Yongwen, Shi, Ruifeng, Zhu, Guangsheng, Zhang, Zihe, Zhang, Hongbing, Liu, Minghui, Wei, Sen, Liu, Hongyu, Chen, Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10470069/
https://www.ncbi.nlm.nih.gov/pubmed/37663243
http://dx.doi.org/10.3389/fphar.2023.1140894
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author Cao, Peijun
Zhao, Qingchun
Li, Yongwen
Shi, Ruifeng
Zhu, Guangsheng
Zhang, Zihe
Zhang, Hongbing
Liu, Minghui
Wei, Sen
Liu, Hongyu
Chen, Jun
author_facet Cao, Peijun
Zhao, Qingchun
Li, Yongwen
Shi, Ruifeng
Zhu, Guangsheng
Zhang, Zihe
Zhang, Hongbing
Liu, Minghui
Wei, Sen
Liu, Hongyu
Chen, Jun
author_sort Cao, Peijun
collection PubMed
description Alectinib has been approved as first-line treatment for anaplastic lymphoma kinase (ALK)-positive non-small cell lung carcinoma. Oncologists are also exploring the possibility of applying alectinib in the perioperative period. Here, we present a patient with locally advanced lung adenocarcinoma associated with EML4-ALK fusion mutation, who received neoadjuvant chemotherapy and alectinib treatment, and then underwent thoracoscopic left lower lung lobectomy. The patient initially received eight chemotherapy cycles and achieved partial remission. After eight cycles of chemotherapy, the lymph nodes in the hilar region again enlarged. The patient was then switched to 4 months of alectinib therapy, but no significant lesion changes were detected on imaging during this period. This raised the question of whether the patient developed alectinib resistance. The pathological findings of the postoperative lung lobe specimens indicated extensive necrosis in the tumor area with no residual tumor cells and massive chronic inflammatory cell infiltration around the tumor area, confirming inconsistency between the imaging findings and pathological results. Multi-point tumor specimen sampling was postoperatively performed. Tumor immune-related gene expression was detected in the sample with the help of the PanCancer IO360™ panel based on the nCounter platform. This is a rare case of a patient who was treated with neoadjuvant alectinib and had paradoxical radiographic findings and pathological responses. The possibility that intratumoral immune heterogeneity was responsible for this phenomenon has been discussed. Based on the findings, it is argued that the pathological response should be an important basis for assessing the effectiveness of neoadjuvant alectinib therapy.
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spelling pubmed-104700692023-09-01 Case Report: ALK rearranged locally advanced lung adenocarcinoma showing inconsistent radiographic findings and pathological responses during neoadjuvant alectinib therapy Cao, Peijun Zhao, Qingchun Li, Yongwen Shi, Ruifeng Zhu, Guangsheng Zhang, Zihe Zhang, Hongbing Liu, Minghui Wei, Sen Liu, Hongyu Chen, Jun Front Pharmacol Pharmacology Alectinib has been approved as first-line treatment for anaplastic lymphoma kinase (ALK)-positive non-small cell lung carcinoma. Oncologists are also exploring the possibility of applying alectinib in the perioperative period. Here, we present a patient with locally advanced lung adenocarcinoma associated with EML4-ALK fusion mutation, who received neoadjuvant chemotherapy and alectinib treatment, and then underwent thoracoscopic left lower lung lobectomy. The patient initially received eight chemotherapy cycles and achieved partial remission. After eight cycles of chemotherapy, the lymph nodes in the hilar region again enlarged. The patient was then switched to 4 months of alectinib therapy, but no significant lesion changes were detected on imaging during this period. This raised the question of whether the patient developed alectinib resistance. The pathological findings of the postoperative lung lobe specimens indicated extensive necrosis in the tumor area with no residual tumor cells and massive chronic inflammatory cell infiltration around the tumor area, confirming inconsistency between the imaging findings and pathological results. Multi-point tumor specimen sampling was postoperatively performed. Tumor immune-related gene expression was detected in the sample with the help of the PanCancer IO360™ panel based on the nCounter platform. This is a rare case of a patient who was treated with neoadjuvant alectinib and had paradoxical radiographic findings and pathological responses. The possibility that intratumoral immune heterogeneity was responsible for this phenomenon has been discussed. Based on the findings, it is argued that the pathological response should be an important basis for assessing the effectiveness of neoadjuvant alectinib therapy. Frontiers Media S.A. 2023-08-17 /pmc/articles/PMC10470069/ /pubmed/37663243 http://dx.doi.org/10.3389/fphar.2023.1140894 Text en Copyright © 2023 Cao, Zhao, Li, Shi, Zhu, Zhang, Zhang, Liu, Wei, Liu and Chen. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Cao, Peijun
Zhao, Qingchun
Li, Yongwen
Shi, Ruifeng
Zhu, Guangsheng
Zhang, Zihe
Zhang, Hongbing
Liu, Minghui
Wei, Sen
Liu, Hongyu
Chen, Jun
Case Report: ALK rearranged locally advanced lung adenocarcinoma showing inconsistent radiographic findings and pathological responses during neoadjuvant alectinib therapy
title Case Report: ALK rearranged locally advanced lung adenocarcinoma showing inconsistent radiographic findings and pathological responses during neoadjuvant alectinib therapy
title_full Case Report: ALK rearranged locally advanced lung adenocarcinoma showing inconsistent radiographic findings and pathological responses during neoadjuvant alectinib therapy
title_fullStr Case Report: ALK rearranged locally advanced lung adenocarcinoma showing inconsistent radiographic findings and pathological responses during neoadjuvant alectinib therapy
title_full_unstemmed Case Report: ALK rearranged locally advanced lung adenocarcinoma showing inconsistent radiographic findings and pathological responses during neoadjuvant alectinib therapy
title_short Case Report: ALK rearranged locally advanced lung adenocarcinoma showing inconsistent radiographic findings and pathological responses during neoadjuvant alectinib therapy
title_sort case report: alk rearranged locally advanced lung adenocarcinoma showing inconsistent radiographic findings and pathological responses during neoadjuvant alectinib therapy
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10470069/
https://www.ncbi.nlm.nih.gov/pubmed/37663243
http://dx.doi.org/10.3389/fphar.2023.1140894
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