Surgical conversion after anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKIs) therapy in N3 stage ALK-positive non-small cell lung cancer: a report of three cases.
- 1Department of Pulmonary Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
Abstract
Anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKIs) can produce substantial and durable tumor regression in ALK-positive non-small cell lung cancer (NSCLC). We report three cases of stage N3 ALK-positive NSCLC patients who successfully underwent surgical resection after ALK-TKIs therapy. Case 1 was a 45-year-old female who had stable disease (SD) after three cycles of docetaxel plus cisplatin and then received crizotinib 250 mg twice daily for 150 days. Tumor diameter decreased by 81%, and she underwent lobectomy with mediastinal lymph-node dissection. The resected lung lesion and sampled nodes showed pathological complete response (pCR) (0/12 nodes). She did not receive postoperative ALK-TKI therapy and developed an isolated brain metastasis 12 months after surgery; treatment with crizotinib and Gamma Knife radiosurgery achieved subsequent disease control, and the reported overall survival (OS) was 83 months. Cases 2 and 3 were 57- and 51-year-old males, who received alectinib 600 mg twice daily for 225 and 135 days, respectively, and both achieved partial response. They underwent wedge resection and segmentectomy with mediastinal lymph-node dissection. Pathology showed non-major pathological response (non-MPR) with 0/5 involved nodes in Case 2 and pCR with 0/10 involved nodes in Case 3. Both continued postoperative alectinib and were alive without recurrence at the reported 64- and 38-month follow-up points, respectively. We report that, in selected patients with stage N3 ALK-positive NSCLC, surgical resection after induction therapy with ALK-TKIs is a feasible therapeutic strategy. Maintenance ALK-TKIs postoperatively may contribute to favorable long-term survival outcomes.
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BibTeX
@article{xiao2026surgical,
title = {{Surgical conversion after anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKIs) therapy in N3 stage ALK-positive non-small cell lung cancer: a report of three cases.}},
author = {Beike Xiao and Hao Guo and Jiatao Zhang and Xue-Ning Yang},
journal = {Translational lung cancer research},
year = {2026},
month = sep,
doi = {10.21037/tlcr-2026-0982},
url = {https://europepmc.org/article/MED/42999646},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Surgical conversion after anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKIs) therapy in N3 stage ALK-positive non-small cell lung cancer: a report of three cases.
AU - Beike Xiao
AU - Hao Guo
AU - Jiatao Zhang
AU - Xue-Ning Yang
PY - 2026
DA - 2026/09/30
JO - Translational lung cancer research
DO - 10.21037/tlcr-2026-0982
UR - https://europepmc.org/article/MED/42999646
AB - Anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKIs) can produce substantial and durable tumor regression in ALK-positive non-small cell lung cancer (NSCLC). We report three cases of stage N3 ALK-positive NSCLC patients who successfully underwent surgical resection after ALK-TKIs therapy. Case 1 was a 45-year-old female who had stable disease (SD) after three cycles of docetaxel plus cisplatin and then received crizotinib 250 mg twice daily for 150 days. Tumor diameter decreased by 81%, and she underwent lobectomy with mediastinal lymph-node dissection. The resected lung lesion and sampled nodes showed pathological complete response (pCR) (0/12 nodes). She did not receive postoperative ALK-TKI therapy and developed an isolated brain metastasis 12 months after surgery; treatment with crizotinib and Gamma Knife radiosurgery achieved subsequent disease control, and the reported overall survival (OS) was 83 months. Cases 2 and 3 were 57- and 51-year-old males, who received alectinib 600 mg twice daily for 225 and 135 days, respectively, and both achieved partial response. They underwent wedge resection and segmentectomy with mediastinal lymph-node dissection. Pathology showed non-major pathological response (non-MPR) with 0/5 involved nodes in Case 2 and pCR with 0/10 involved nodes in Case 3. Both continued postoperative alectinib and were alive without recurrence at the reported 64- and 38-month follow-up points, respectively. We report that, in selected patients with stage N3 ALK-positive NSCLC, surgical resection after induction therapy with ALK-TKIs is a feasible therapeutic strategy. Maintenance ALK-TKIs postoperatively may contribute to favorable long-term survival outcomes.
SN - 2218-6751
SN - 2226-4477
ER -