Ensartinib targeted conversion surgery for ALK-positive unresectable locally advanced non-small cell lung cancer: a case report

Currently, there is limited evidence supporting ensartinib’s efficacy as a neoadjuvant treatment for locally advanced anaplastic lymphoma kinase (ALK)-positive non–small cell lung cancer (NSCLC). This case study describes a 65-year-old female who presented with an incidental pulmonary lesion and was diagnosed with unresectable locally advanced stage IIIB (cT3N2M0) ALK-positive NSCLC. After multidisciplinary evaluation, she underwent 12 weeks of neoadjuvant ensartinib therapy (225 mg/day, later reduced to 175 mg/day), achieving a 78.4% reduction in tumor volume and reassessment as resectable. Subsequently, video-assisted thoracoscopic surgery (VATS) comprising a right upper lobectomy and systematic lymph node dissection resulted in R0 resection. Postoperative pathological analysis confirmed pathological complete response (pCR). During an fifteen-month follow-up, no recurrence of the disease was detected. These results indicate that ensartinib may provide potential benefit for patients with locally advanced ALK-positive NSCLC by optimizing surgical feasibility and survival outcomes.