VATS right upper lobectomy after alectinib administration for ALK-positive lung adenocarcinoma

Abstract

Systemic chemotherapies, several molecular-targeted agents, or immune checkpoint inhibitors are selected as main treatments for advanced non-small lung cancer. However, with molecular-targeted agents, most patients eventually experience tumor progression due to acquired resistance. The role of residual or recurrent tumor resection after the treatment is unclear.

A 65-year-old man was referred to our hospital due to an abnormal radiographic image. Chest CT revealed a 50-mm solid mass in the right upper lobe. The tumor involved the hilar lymph node and extended to the upper lobar bronchus. Head MRI revealed a 10-mm brain metastasis in the left parietal lobe. He was initially diagnosed with adenocarcinoma (cT2bN1M1b Stage IVA) by transbronchial lung biopsy. Then, brain metastasis was removed surgically. He was finally diagnosed with ALK-rearranged adenocarcinoma from tissue of the brain metastasis.

Alectinib (600 mg/day) was started as the first-line therapy. After 14 months of alectinib therapy, chest CT revealed marked reduction of the tumor and two other lesions in the right upper lobe. One was a 10-mm nodule close to the scar of the primary tumor, which had not been found on chest CT three months ago. The other was a 14-mm nodule apart from the scar, which existed before alectinib treatment and had gradually enlarged. We performed complete VATS right upper lobectomy and mediastinal lymph node dissection for treatment and diagnosis.

Histopathlogical diagnoses: No residual viable cell was found in the primary lesion. The lesion close to the scar of the primary lesion was a recurrent lesion. The lesion apart from the scar was primary lung cancer.

When we find a new lesion, it is important to try to make a histopathological diagnosis and decide on the course of treatment actively, if possible.