Case report: Pathological complete response to neoadjuvant brigatinib in stage III non-small cell lung cancer with ALK rearrangement

TL;DR

A patient with stage III non-small cell lung cancer achieved a complete tumor response after treatment with brigatinib before surgery.

Contribution

This case report demonstrates a pathological complete response to neoadjuvant brigatinib in ALK-positive NSCLC.

Findings

Neoadjuvant brigatinib therapy led to a significant reduction in tumor size.

Surgery revealed no residual tumor cells, indicating a pathological complete response.

The patient remained disease-free for 13 months after treatment.

Abstract

The use of neoadjuvant anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitors (TKIs) has not been extensively explored. The current case report highlights the notable pathological complete response (pCR) achieved following neoadjuvant brigatinib therapy in a patient with stage IIIA ALK-positive non-small cell lung cancer (NSCLC).

A 32-year-old male presented with incidental lung lesions, ultimately diagnosed as clinical stage T3N1M0, IIIA NSCLC with an ALK gene rearrangement. Following a multidisciplinary discussion, the patient opted for neoadjuvant brigatinib therapy, which significantly reduced the tumor size. Subsequently, surgery with curative intent was performed, revealing pCR with no residual tumor cells. The patient remained disease-free during a 13-month follow-up period.

This case report provides compelling evidence of pCR following brigatinib therapy in ALK-positive NSCLC, suggesting that surgery after neoadjuvant therapy with brigatinib may offer a safe and effective approach for patients with ALK-positive NSCLC.

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