The following is a summary of “Salvage Surgery After First-Line Alectinib for Locally-Advanced/Metastatic ALK-Rearranged NSCLC: Pathological Response and Perioperative Results,” published in the July 2023 issue of the Clinical Lung Cancer by Lococo et al.

The significance of salvage surgery following tyrosine kinase inhibitors in advanced non-small cell lung cancer depends on oncogenes is mainly unexplored. Researchers sought to describe the pathological characteristics and early surgical outcomes of Anaplastic Lymphoma Kinase-positive non-small cell lung cancer patients undergoing surgery following first-line alectinib therapy. They retrospectively collected and analyzed multicentric data on ten patients treated with alectinib for advanced-stage anaplastic lymphoma kinase-positive lung adenocarcinoma and undergoing anatomical surgical resection between January 2020 and December 2021. 

All patients who received alectinib (600 mg twice daily) were untreated. Surgery was always recommended following multidisciplinary consultation. Pathological response and surgical feasibility (intraoperative complications and postoperative outcomes) were the primary endpoints. Alectinib was administered for a mean of 212 days before surgery (range: 42- 415 days) and was typically discontinued one week before surgery (range: 0 to 32 days) with no patient experiencing grade 4 toxicity. All patients received an R0 resection, with lobectomy in eight cases, lobectomy in one, and (left) pneumonectomy in one. In seven cases (70%), intra-operative complications were reported, primarily owing to perivascular fibrosis or thickening of mediastinal lymph node tissues. 

Major and minor complications occurred in 0% and 30% of cases. In 50% and 90% of cases, complete and substantial pathological responses (0% and <10% viable tumor cells, respectively) were observed. Despite short follow-up, only one tumor recurrence was observed (in the only patient who did not recommence alectinib after surgery). After Alectinib for advanced lung adenocarcinoma, salvage surgery was safe and practicable despite some intraoperative technical complications.

Source: sciencedirect.com/science/article/abs/pii/S152573042300044X