Janson Mélanie, Curcio Hubert, Le Rochais Jean-Philippe, Planchard Gaëtane, Demontrond Pierre, Gervais Radj
François BACLESSE, Comprehensive Cancer Center, Caen, France.
Department of Cardiovascular and Thoracic Surgery, University Hospital of Caen, Caen, France.
Transl Lung Cancer Res. 2025 Jul 31;14(7):2869-2874. doi: 10.21037/tlcr-2025-254. Epub 2025 Jul 28.
Stage IV non-small cell lung cancer is not a curative stage. However, a novel approach to local treatment of the primary tumor may improve progression-free survival. The choice between radiotherapy or surgery, as well as the optimal timing for these treatments remains to be determined. We report here the first case, to our knowledge, of a multi-metastatic patient treated with consolidative surgery after neoadjuvant alectinib, resulting in a complete pathological response.
The patient was, as is typically observed in populations with oncogenic alterations such as anaplastic lymphoma kinase () rearrangements, a young and non-smoker; however, he was male. Bronchial endoscopy confirmed the diagnosis of bronchopulmonary adenocarcinoma with strong expression demonstrated by immunohistochemistry. We initiated alectinib as first-line treatment for metastatic disease; however, due to the induced oligo-metastatic disease, a local treatment of the primary tumor was discussed during multidisciplinary board. Lobectomy was performed and histological examination confirmed the complete pathological response. Adjuvant alectinib was continued for unspecified duration due to the lack of available data.
This case suggests that local treatment, even in patients with stage IV disease, performed at the time of the best response to systemic therapy, may offer an improvement in progression free survival and perhaps a glimpse of a cure.
IV期非小细胞肺癌并非可治愈阶段。然而，一种针对原发性肿瘤的新型局部治疗方法可能会改善无进展生存期。放疗或手术之间的选择以及这些治疗的最佳时机仍有待确定。据我们所知，我们在此报告首例在新辅助使用阿来替尼后接受巩固性手术治疗的多转移患者，该患者获得了完全病理缓解。
该患者如在具有致癌改变（如间变性淋巴瘤激酶（ALK）重排）的人群中通常观察到的那样，是一名年轻且不吸烟的患者；然而，他是男性。支气管内镜检查确诊为支气管肺腺癌，免疫组化显示强表达。我们启动阿来替尼作为转移性疾病的一线治疗；然而，由于诱导产生寡转移疾病，在多学科讨论会上讨论了对原发性肿瘤的局部治疗。进行了肺叶切除术，组织学检查证实了完全病理缓解。由于缺乏可用数据，辅助性阿来替尼持续使用了未指定的时长。
该病例表明，即使是IV期疾病患者，在对全身治疗的最佳反应时进行局部治疗，可能会改善无进展生存期，甚至可能带来治愈的希望。
