Surgical treatment of IIIb (N2), ROS1(+) non-small cell lung cancer after neoadjuvant chemotherapy combined with targeted therapy: a case report.

Abstract

Background: Non-small cell lung cancer accounts for more than 85% of lung malignancies. Preoperative neoadjuvant therapy is considered to be a method that can improve the long-term prognosis of locally advanced non-small cell lung cancer, and radiotherapy and chemotherapy are the main treatment options. With the continuous discovery of different targets, more and more targeted drugs benefit more patients, but there are few reports on the treatment mode of targeted neoadjuvant combined chemotherapy. In this study, we report a case of targeted combination chemotherapy as a new adjuvant option for locally advanced lung adenocarcinoma, with a view to providing more treatment references for similar patients. ROS proto-oncogene 1 (ROS1) rearrangements are observed in 1-2% of patients with non-small cell lung cancer (NSCLC). It is a clinically rare mutation, and patients with ROS1 fusions have been shown to be highly sensitive to treatment with crizotinib. However, the efficacy and safety of crizotinib combined with neoadjuvant chemotherapy in patients with locally advanced NSCLC remain to be elucidated.

Case description: We report the case of a 49-year-old male who was diagnosed with stage IIIb (N2) lung adenocarcinoma. Next-generation sequencing revealed ROS1 fusions, and crizotinib was given simultaneously with targeted therapy during neoadjuvant chemotherapy. After 3 cycles of chemotherapy, surgery was performed, and the pathological results revealed major pathological response (MPR). Two years later, local and general examinations revealed no evidence of tumour recurrence.

Conclusions: This study highlights the effective exploration of the combination of targeted therapy and chemotherapy in the neoadjuvant treatment mode of locally advanced non-small cell lung cancer. For patients with sensitive genetic mutations, early use may benefit the patient more, just as the most effective time to use a fire extinguisher is when the flame starts.