Comparison of salvage surgeries for lung adenocarcinoma treated with anaplastic lymphoma kinase-tyrosine kinase inhibitors

Abstract

Introduction: The therapeutic efficacy of anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitor (TKI) is significant for ALK-rearranged advanced lung cancer. There have been several reports of salvage surgery for advanced lung cancer treated with ALK-TKIs. We report two cases of salvage surgery after treatment with different ALK-TKIs and reviewed the literature. Case 1: A 59-year-old male patient with ALK-rearranged lung adenocarcinoma, clinical-stage ⅣB (T3N2M1c) was treated with alectinib for 18 months. The pulmonary metastasis was enlarged, and lobectomy was performed as a salvage surgery. Although there was a slight adhesion between the hilar lymph nodes and the pulmonary artery, the operation was completed without any problems. The histopathology of the primary lesion revealed pathologic complete response. Case 2: A 45-year-old male patient with ALK-rearranged lung adenocarcinoma, clinical-stage ⅣA (T4N2M1b) was treated with crizotinib for 71 months after chemotherapy. The primary lesion was enlarged, and lobectomy was performed as a salvage surgery. There was severe adhesion between the hilar lymph node and pulmonary artery, which was extremely difficult to dissect. Histopathology of the primary lesion revealed viable tumor cells without degeneration or necrosis, and there was rigid fibrosis between the bronchus and vessels. Conclusion: In previous literature, salvage surgery cases after alectinib administration had better pathologic responses and were easier to perform than surgeries after crizotinib administration. From the two cases and the literature review of this study, various types of ALK-TKIs had different pathologic responses and effects on salvage surgery. Salvage surgery may be considered as a treatment strategy, especially for patients receiving alectinib instead of crizotinib.

Keywords

• ALK-rearrangement
• Salvage surgery
• Therapeutic efficacy