Neoadjuvant ceritinib treatment in ALK‐rearranged locally advanced adenosquamous carcinoma: A case report

• Published in: Thoracic cancer 2022-08, Vol.13 (15), p.2275-2278
• Main Authors: Mai, Shixiong, Wang, Yue, Wang, Xuemei, Yang, Wei, Gao, Haicheng, Xu, Zhenan, Xu, Lei, Xu, Li, Ou, Qiuxiang, Chen, Hanlin, Wang, Zhenxing
• Format: Article
• Language: English
• Subjects: adenosquamous carcinoma; ALK‐rearranged; Anaplastic Lymphoma Kinase; Antineoplastic Agents - therapeutic use; Biopsy; Cancer therapies; Carcinoma, Adenosquamous - drug therapy; Carcinoma, Adenosquamous - genetics; Case Report; Case Reports; ceritinib; Chemotherapy; Enzymes; Genes; Histology; Humans; Lung cancer; Lung Neoplasms - chemically induced; Lung Neoplasms - drug therapy; Lung Neoplasms - genetics; Lymphatic system; Metabolism; Metastasis; Mutation; Neoadjuvant Therapy; non‐small cell lung cancer; Patients; Polymorphism; Protein expression; Protein Kinase Inhibitors - therapeutic use; Pyrimidines; Receptor Protein-Tyrosine Kinases - therapeutic use; Sulfones; Surgery; Tomography
• ISSN: 1759-7706; 1759-7714
• DOI: 10.1111/1759-7714.14558

Here, we first report a case of neoadjuvant ceritinib for locally advanced lung adenosquamous carcinoma. In this study, a locally advanced adenosquamous carcinoma (ASC) patient with EML4‐ALK fusion who achieved a partial response with neoadjuvant ceritinib treatment after a cycle of neoadjuvant chemotherapy did not show significant efficacy. A complete surgical resection was performed with mild adhesions and a small amount of bleeding intraoperatively. The EML4‐ALK fusion was detected by targeted next‐generation sequencing (NGS) in both pretreatment biopsy and the postoperative tissue specimens with a dramatic decrease in the allele frequency (26.2% [pre]–2.3% [post]). Pathological examination of the postoperative specimens indicated a diagnosis of ASC but the proportions of adenocarcinoma and squamous cell carcinoma cells in the primary lung tumor and metastatic lymph node site were different, suggesting the various responses to ceritinib. Thus, with the case presented here, we provide the clinical evidence for ALK‐positive locally advanced ASC patients benefiting from neoadjuvant ceritinib treatment with a tolerable safety profile, whereas further cohort studies of the efficacy and safety of neoadjuvant ceritinib in such patients are needed. Here, we report a case of neoadjuvant ceritinib for locally advanced lung adenosquamous carcinoma. The treatment for this patient was replaced with neoadjuvant ceritinib after the failure of neoadjuvant chemotherapy and surgical R0 resection was achieved. We present the argument for neoadjuvant therapeutic strategies as a reasonable option for such patients.