AUTHOR=Zhai Xiaoqian , Wang Ting , Lin Yiyun , Zhang Jiabi , Wang Yuqing , Wang Weiya , Zhou Qinghua , Zhu Daxing 

TITLE=Case report: Complete pathological admission in N3 unresectable locally advanced lung adenocarcinoma with a novel INTS10-ALK and EML4-ALK fusion after neoadjuvant crizotinib

JOURNAL=Frontiers in Oncology

VOLUME=Volume 13 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1104910

DOI=10.3389/fonc.2023.1104910

ISSN=2234-943X

ABSTRACT=Background: Although anaplastic lymphoma kinase tyrosine kinase inhibitors (ALK-TKIs) have impressive response in advanced lung adenocarcinoma with anaplastic lymphoma kinase (ALK) fusion, no guidelines points to the potential benefits of neoadjuvant ALK-TKIs for N3 unresectable locally advanced lung cancer. Current ongoing clinical trial mainly focus on the efficacy of neoadjuvant ALK-TKI in resectable locally advanced lung cancer and ignore the role of neoadjuvant ALK-TKI in N3 unresectable locally advanced lung cancer.
Materials and Methods: We report a lung cancer case with a novel INTS10-ALK and EML4-ALK rearrangement achieved complete pathologic responses to neoadjuvant crizotinib.
Results: Our study reported a stage IIIB-N3 lung adenocarcinoma with an unreported dual ALK rearrangement (INTS10-ALK and EML4-ALK) received 5 months of crizotinib, followed by R0 right upper lobectomy, achieving complete pathological response (ypT0 ypN0). No recurrence of tumor was found for 3 years post-operatively.
Conclusion: The case supports the strategy of neoadjuvant ALK inhibitors for N3 unresectable locally advanced lung cancer may be available, expanding the spectrum of treatment of stage IIIB-N3 lung cancer.