Salvage Surgery After First-Line Alectinib for Locally-Advanced/Metastatic ALK-Rearranged NSCLC: Pathological Response and Perioperative Results

Filippo Lococo*, Alessandra Cancellieri, Marco Chiappetta, Alessandro Leonetti, Giuseppe Cardillo, Francesca Zanelli, Giuseppe Mangiameli, Luca Toschi, Gianluca Guggino, Francesco Jacopo Romano, Giovanni Leuzzi, Claudia Proto, Lorenzo Spaggiari, Filippo De Marinis, Emanuele Vita, Luca Ampollini, Stefano Margaritora, Marcello Tiseo, Emilio Bria

*Corresponding author

Research output: Contribution to journalArticle

Abstract

Background: The role of salvage surgery after tyrosine kinase inhibitors in advanced oncogene-addicted non-small cell lung cancer is largely unexplored. Patients: We aimed to describe the pathological features and surgical early-outcomes of Anaplastic Lymphome Kinase anaplastic lymphome kinase positive non-small cell lung cancer patients undergoing surgery after first-line alectinib treatment. We retrospectively collected and analyzed multicentric data of 10 patients treated with alectinib for advanced-stage anaplastic lymphome kinase positive lung adenocarcinoma who underwent anatomical surgical resection from January 2020 to Decemeber 2021. All patients were treatment naive and received alectinib (600 mg twice daily). Surgery was always proposed after multidisciplinary discussion. The primary endpoints were pathological response and surgical feasibility (technical intraoperative complications, postoperative outcomes). Results: Alectinib was received for a mean of 212 days before surgery (42-415 days) and was generally interrupted about one week before surgery (range: 0-32 days) with no patient experienced grade 4 toxicity. All patients received an R0 resection with surgery consisting of lobectomy in 8 cases with bilobectomy and (left) pneumonectomy in 1 case each. Intra-operative difficulties were described in 7 cases (70%), mostly due to perivascular fibrosis or thickening of mediastinal lymph nodal tissues. Major and minor complications occurred in 0 and 3 cases (30%), respectively. A pathological complete response and major pathological response (defined as 0% and < 10% viable tumor cells, respectively) were observed in 50% and 90% of cases, respectively. Despite short follow-up, only one tumor recurrence was observed (in the only patient who did not resume alectinib after surgery). Interpretation: Despite some technical intraoperative difficulties, salvage surgery was safe and feasible after Alectinib for advanced lung adenocarcinoma.
Original languageEnglish
Pages (from-to)467-473
Number of pages7
JournalClinical Lung Cancer
Volume24
DOIs
Publication statusPublished - 2023

Keywords

  • ALK-rearrangement
  • Lung cancer
  • TKI
  • Target therapy
  • Radical resection

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