ALK-targeted adjuvant treatment in NSCLC: A Case Report

Non-small cell lung cancer (NSCLC) is the second most common malignancy and the leading cause of cancer-related death worldwide. Platinum-based chemotherapy has been the standard of postsurgery care for early and locally advanced disease for many years, which only accounted for 4–5% increase in 5-year survival. Recent advances in biomarkers have altered the drug treatment paradigm for patients with NSCLC, first of all for advanced stages of disease. They were predictably integrated and successfully applied in the adjuvant settings, resulting in significant improvements in cancer care outcomes. Osimertinib was the first example of effective adjuvant targeted therapy in NSCLC for the treatment of tumours with epidermal growth factor receptor (EGFR) mutations, which updated the feasibility of using this strategy for other oncogenic drivers, in particular, ALK translocation. The Food and Drug Administration (FDA) approved alectinib as adjuvant treatment for anaplastic lymphoma kinase (ALK)-positive NSCLC on April 18, 2024. This approval was based on the results of the ALINA trial, which demonstrated that alectinib significantly prolonged a disease-free survival compared with the standard platinum-based chemotherapy. The clinical case described in the article demonstrates the experience of treating a 41-year-old woman with ALK-positive stage IIIA NSCLC, who started the postoperative therapy with alectinib after surgical treatment in November 2023.