Background: This study was designed to investigate the outcomes after neoadjuvant targeted therapy in patients with anaplastic lymphoma kinase (ALK) or ROS proto-oncogene 1 (ROS1) rearrangement locally advanced non-small cell lung cancer (NSCLC) in the real world.
Methods: Patients with ALK or ROS1 rearrangement locally advanced NSCLC received neoadjuvant targeted therapy between October 2018 and December 2023 in Shanghai pulmonary hospital were enrolled in this study. Perioperative and follow-up data of these patients were retrospectively recorded.
Results: Thirty-eight patients were enrolled in this study. ALK and ROS1 rearrangement were confirmed in 32 (84.2%) and 6 (15.8%) patients respectively. Neoadjuvant targeted therapy was performed a mean of 4.1 ± 3.4 months. Patients with yc IA disease had significant tumor shrinkage compared with the others (-51.4 ± 16% vs. -41.7 ± 16.6 %, P ≤ 0.05). All patients had R0 resection. Pathological complete response and major pathological response were observed in 12 (31.6%) and 13 (34.2%) patients respectively. The mean overall survival time was 23.5 ± 13.5 months, and the mean disease-free survival (DFS) time was 19.2 ± 9.4 months. Kaplan-Meier analysis showed patients with histologic grade 3 had worse DFS compared with the others. Univariate and multivariable Cox regression analyses showed histologic grade 3 was an independent risk factor of DFS.
Conclusions: Results of this study preliminary showed the safety and feasibility of surgery after neoadjuvant targeted therapy in some locally advanced NSCLC patients with ALK or ROS1 mutation. Histologic grade 3 was an independent risk factor of DFS for these patients.
Keywords: ALK; Neoadjuvant targeted therapy; Non-small cell lung cancer; ROS1; Surgery.
© 2025. Society of Surgical Oncology.