Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510062, China.
Curr Oncol. 2024 Jun 30;31(7):3808-3814. doi: 10.3390/curroncol31070281.
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.
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，对于携带罕见基因突变（如 RET）的某些 NSCLC 患者，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。在本报告中，我们描述了一位 58 岁男性患者的病例，他患有 IIIA 期 NSCLC，接受了完全肺叶切除术和选择性淋巴结清扫术。术后下一代测序显示患者携带罕见的 KIF13A-RET 融合。患者选择接受普拉替尼单药辅助治疗，并在手术后进行连续循环肿瘤 DNA（ctDNA）监测。在随访期间，尽管经历了剂量减少和不规则用药，但患者仍实现了令人满意的无病生存期（DFS）27 个月。此外，ctDNA 预测肿瘤复发的时间比影像学技术早 4 个月。在复发时将贝伐珠单抗加入原方案仍然有益。普拉替尼作为辅助治疗显示出有前景的疗效，而 ctDNA 分析为早期发现肿瘤复发提供了有价值的工具。通过利用靶向治疗和创新监测技术，我们旨在提高未来 NSCLC 患者的治疗效果和生活质量。
