Shi Liang, Gao Shuhong, Tong Li, Meng Qiyi, Zhou Shijie, Yu Daping, Dong Yujie, Liu Zhe
Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China.
Department of Thoracic Surgery, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China.
Front Oncol. 2023 Jun 20;13:1120511. doi: 10.3389/fonc.2023.1120511. eCollection 2023.
Despite the promising efficacy and tolerability of alectinib in treating advanced anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC), the role of alectinib in neoadjuvant setting remains understudied in ALK-rearranged resectable lung cancer.
Our report concerns two cases of early-stage NSCLC with complete pathologic responses to off-label use of long-course neoadjuvant alectinib. PubMed, Web of Science, and Cochrane Library were searched comprehensively for ALK-positive resectable cases with neoadjuvant alectinib. The papers were chosen following PRISMA recommendations. Seven cases from the literature and two present cases were evaluated.
Two cases with stage IIB (cT3N0M0) EML4-ALK lung adenocarcinoma received long-course (more than 30 weeks) of neoadjuvant alectinib followed by R0 lobectomy with the complete pathological response. In our systematic review, 74 studies were included in the original search. Application of the screening criteria resulted in 18 articles deemed eligible for full-text reading. Following the application of the exclusion criteria, out of six papers, seven cases were selected for inclusion in the final analysis and were included in the systematic review. None of the studies were included in the quantitative analysis.
We report two cases of lung adenocarcinoma with resectable ALK-positive that achieved pCR with long-course neoadjuvant alectinib. Our cases and a systematic review of the literature support the feasibility of neoadjuvant alectinib treatment for NSCLC. However, large clinical trials must be conducted in the future to determine the treatment course and efficacy of the neoadjuvant alectinib modality.
https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022376804.
尽管阿来替尼在治疗晚期间变性淋巴瘤激酶（ALK）阳性非小细胞肺癌（NSCLC）方面具有良好的疗效和耐受性，但在ALK重排的可切除肺癌新辅助治疗中，阿来替尼的作用仍未得到充分研究。
我们报告了两例早期NSCLC患者，他们对长疗程新辅助阿来替尼的非标签使用有完全病理反应。全面检索了PubMed、科学网和Cochrane图书馆，以查找接受新辅助阿来替尼治疗的ALK阳性可切除病例。按照PRISMA建议选择论文。对文献中的7例病例和本研究中的2例病例进行了评估。
两例IIB期（cT3N0M0）EML4-ALK肺腺癌患者接受了长疗程（超过30周）的新辅助阿来替尼治疗，随后进行了R0肺叶切除术，并获得了完全病理反应。在我们的系统评价中，最初检索到74项研究。应用筛选标准后，18篇文章被认为符合全文阅读要求。应用排除标准后，从6篇论文中选择了7例病例纳入最终分析，并纳入系统评价。没有研究纳入定量分析。
我们报告了两例ALK阳性可切除肺腺癌患者，他们通过长疗程新辅助阿来替尼治疗实现了病理完全缓解（pCR）。我们的病例和文献系统评价支持新辅助阿来替尼治疗NSCLC的可行性。然而，未来必须进行大型临床试验，以确定新辅助阿来替尼治疗方案的疗程和疗效。
