# Association Between ALK Rearrangement and Ultra-Late Recurrence in Lung Cancer: Case Report and Pooled Analysis

## TL;DR

This paper reports a rare case of ultra-late lung cancer recurrence and finds that ALK rearrangement is a significant predictor of recurrence timing.

## Contribution

The study identifies ALK rearrangement as a novel predictor of ultra-late recurrence in non-small cell lung cancer.

## Key findings

- A case of ultra-late recurrence in a lung cancer patient was reported with EGFR exon 20 insertion.
- Multivariable analysis showed ALK rearrangement significantly predicts time to recurrence in NSCLC.
- Ultra-late recurrence is rare and occurs more than 10 years after initial treatment.

## Abstract

Ultra-late recurrence, defined as recurrence occurring 10 years or longer after curative treatment, is uncommon for non-small cell lung cancer (NSCLC). To date, factors associated with ultra-late recurrence remain unknown. We report a case with ultra-late recurrence and reviewed the literature published during 2010-2023.

This is a case of a 66-year-old woman, with a significant smoking history and a previous history of lung adenocarcinoma, who underwent surgery for a brain metastasis detected on imaging. The pathology confirmed lung adenocarcinoma with an epidermal growth factor receptor (EGFR) exon 20 insertion, a finding consistent with the initial lung surgery a decade ago. With receiving intrathecal topotecan, the patient has maintained stable disease 10 months post-surgery.

Given the rarity of ultra-late recurrence of NSCLC, we also conducted a pooled analysis with the outcome of interest being a time to recurrence. Data from this case report was analyzed along with previously published 26 cases of ultra-late recurrence. Multivariable analysis indicated that the only factor significantly predicting time to recurrence was anaplastic lymphoma kinase (ALK) rearrangement.