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

The treatment of stage IIIB non‐small cell lung cancer (NSCLC) is complicated, the best strategy is chosen individually and surgery is usually not recommended. A 50‐year‐old female was diagnosed with locally advanced lung adenocarcinoma (stage IIIB, T2bN3M0). Fluorescence in situ hybridization (FISH) analysis revealed an ALK rearrangement. Crizotinib was administered and progression was seen after five months. The patient then received ceritinib with a palliative intent, which led to downstaging (IIIA[N2]) with a radiological and metabolic response. Right lower lobe lobectomy was performed at 12 months post‐surgery, and the patient is still disease‐free according to the last computed tomography (CT) scan. The unintended downstaging from ceritinib provided a chance for resection in our patient who had ALK‐positive stage IIIB NSCLC after the failure of first‐line crizotinib, indicating potential usage of ceritinib in the neoadjuvant setting. Future perspective trials are warranted to investigate the role of ceritinib in earlier stages as a primary drug.
Neoadjuvant chemotherapy can improve tumor resectability and survival. Despite some evidence that indicates potential efficacy of targeted therapies in patients with resectable NSCLC, the role of neoadjuvant ALK‐TKIs therapy is not clearly defined. The current report revealed that neoadjuvant treatment with the ALK tyrosine kinase inhibitor ceritinib in a crizotinib‐relapsed, stage IIIB lung adenocarcinoma led to downstaging and conversion to resectable status with pathological complete response. Prospective data are warranted to provide solid evidence to assess the potential efficacy of neoadjuvant ceritinib as a primary drug in earlier stages.