Complete Resection Following Alectinib Administration for Stage IIIA-N2 ALK-translocated Non-small Cell Lung Cancer

Background. Anaplastic lymphoma kinase (ALK) inhibitors have been promising therapeutic agents for unresectable ALK-translocated non-small cell lung cancer (NSCLC). For stage IIIA-N2 (N2-IIIA) ALK-translocated lung cancer, however, the efficacy of ALK inhibitors compared with concurrent chemoradiotherapy, which is considered the standard treatment, remains unclear. Case. In a 56-year-old woman, an abnormal shadow was noted on chest X-ray. Chest computed tomography (CT) showed a 4.5×2.8-cm-diameter mass in the right lung S3 with multiple enlarged lymph nodes in the hilum and mediastinum. Positron-emission tomography (PET)-CT revealed some accumulation in the mass and lymph nodes. A transbronchial biopsy from the S3 mass demonstrated ALK-translocated NSCLC. She was diagnosed with unresectable N2-IIIA ALK-translocated NSCLC and administered the ALK inhibitor alectinib. Eight weeks later, CT showed a remarkable decrease in the size of the tumors and lymph nodes. We then performed right upper lobectomy with mediastinal lymph node dissection for the local residual tumors. A pathological examination revealed no viable neoplastic cells in any resected specimens, indicating pathological complete response. She was free of disease 18 months after surgery with alectinib treatment. Conclusion. Remarkable tumor reduction by alectinib administration, which is an exploratory therapeutic option, enabled us to perform surgical complete resection for unresectable N2-IIIA ALK-translocated NSCLC.