The role of salvage surgery after tyrosine kinase inhibitors in advanced oncogene-addicted NSCLC is largely unexplored.
We aimed to describe the pathological features and surgical early-outcomes of ALK positive NSCLC patients undergoing surgery after first-line alectinib treatment. We retrospectively collected and analyzed multicentric data of 10 patients treated with alectinib for advanced-stage ALK-positive lung adenocarcinoma who underwent anatomical surgical resection from 01/2020 to 12/2021. All patients were treatment naive and received alectinib (600mg twice daily). Surgery was always proposed after multidisciplinary discussion. The primary endpoints were pathological response and surgical feasibility (technical intra-operative complications, post-operative outcomes).
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 one 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).
Despite some technical intra-operative difficulties, salvage surgery was safe and feasible after Alectinib for advanced lung adenocarcinoma.
Results of “salvage surgery” after first-line Alectinib treatment has never been explored till now. We retrospectively collected and analyzed 10 highly-selected patients treated with alectinib for advanced-stage ALK-positive lung cancer who underwent anatomical surgical resection after discussion at local multidisciplinary tumor board. No patient experienced grade 4 toxicity. All patients received an R0 resection. Intra-operative difficulties were described in 70% of cases but major and minor complications occurred in 0 and 3 cases (30%) only, respectively. High rates of pathological complete response (50%) and major pathological response (90%) were observed in this cohort. Despite a short follow-up, only one tumor recurrence was observed.
In conclusion, despite some technical intra-operative difficulties, salvage surgery was safe and feasible in selected advanced lung cancer cases with good response after Alectinib treatment.
Abbreviation::CR (Complete Response), MPR (Major Pathological Response), PCR (Pathological Complete Response), PR (Partial Response), ALK (Anaplastic Lymphome Kinase), CT (computed tomography), EBUS (Endobronchial Ultrasound), FNAB (Fine-needle biopsy), NSCLC (Non Small Cell Lung Cancer), PET (Positron emission Tomography), RECIST (Response Evaluation Criteria in Solid Tumors), TBNA (Trans-bronchial needle-aspiration), TKI (Tyrosine Kinase Inhibitors), VATS (video assisted thoracic surgery)
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Accepted: March 5, 2023
Received in revised form: February 20, 2023
Received: January 21, 2023
Publication stageIn Press Journal Pre-Proof
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