Rapid Postoperative Relapse in ALK-Positive Locally Advanced NSCLC Patient with Complete Pathological Response to Neoadjuvant Crizotinib

Abstract

with their long-term use. Moreover, corticosteroids may also increase the progression and spread of cancer. What is more, recent studies have emphasized that early use of steroids can damage their clinical benefit. Studies found that when corticosteroids were used at baseline (10 mg of prednisone equivalent) or in the early period of treatment (during the first 30 days), patients with NSCLC had significantly poorer overall survival. 4,5 Using alternatives to steroids (such as antihistamines) may also be an effective treatment in for low-grade skin irAEs. Using steroids appropriately according to the guideline for irAEs in a multidisciplinary approach is recommended. With regard to organ-specific irAEs, especially skin and endocrine system irAEs, better management of irAEs could maximize therapeutic efficacy. On the other hand, in cases involving patients who obtain a greater benefit from use of ICIs, irAEs also need to be monitored closely. Caution is required when using steroids in the early period of treatment. In the future, a better understanding of the pathophysiologic mechanism of irAEs and investigation of who will experience development of irAEs will help to prevent irAEs in the early stage of treatment and sustain the immunotherapy to maximize therapeutic efficacy.

Complete pathological response and negative postoperative ctDNA were not predictive of discontinuation of adjuvant crizotinib therapy in a patient with locally advanced MET ex14 skipping mutation-positive non-small cell lung cancer: a case report

“…However, the patient experienced rapid metastasis after discontinuation of short-term postoperative adjuvant crizotinib therapy. Zhong reported an ALK fusion mutation NSCLC patient who achieved pCR but developed rapid relapse due to discontinuation of crizotinib adjuvant therapy with negative ctDNA following 3.6 months of crizotinib adjuvant therapy ( 8 ). Altogether, these data indicated that neither complete pathological response nor negative ctDNA could be an effective predictor for discontinuation of short-term adjuvant targeted therapy in locally advanced NSCLC patients harboring MET ex14 mutation with complete surgical resection and also indicated the importance of long-term continuous postoperative crizotinib therapy even with negative ctDNA.…”

Pathological complete response to neoadjuvant ceritinib of a crizotinib‐resistant, stage IIIB non‐small cell lung cancer with ALK rearrangement: A case report

“…4 However, postoperative relapse was seen with the emergence of an ALK mutation. 5 Acquired ALK mutations accounts for about one third of resistance to crizotinib, and several acquired resistance mutations have been identified including L1196M, G1269A, 1151Tins, L1152R, C1156Y, G1202R, and S1206Y mutations. 6 CNS relapse is another cause of treatment failure due to the poor penetration of crizotinib through the blood brain barrier.…”

Challenges of neoadjuvant targeted therapy in early stage non-small cell lung cancer—a narrative review

“…There are several case reports on neoadjuvant crizotinib (60,61), and alectinib (62-65) as well, pointing to neoadjuvant ALK TKI approach as feasible, efficient and well tolerated.…”