Fertility preservation before initiation of adjuvant alectinib in early-stage ALK-positive non–small cell lung cancer: A first case report

Adjuvant alectinib for resected ALK-positive non-small cell lung cancer (NSCLC) offers a window for fertility preservation (FP) for adolescent and young adult (AYA) patients not previously available for patients with advanced disease. A 39-year-old nulliparous woman was incidentally diagnosed with Stage IIB (pT2aN1M0) ALK-positive lung adenocarcinoma and underwent lobectomy. Due to her desire for future childbearing, she was referred to a reproductive specialist one month postoperatively. She successfully underwent controlled ovarian stimulation, resulting in the cryopreservation of three oocytes. The process took approximately two weeks, allowing adjuvant alectinib to be initiated two months postoperatively without delay. This case demonstrates that multidisciplinary collaboration between oncology and reproductive specialists ensures that FP is feasible for AYA patients with early stage ALK-positive NSCLC. Comprehensive survivorship care must include oncofertility in the era of effective targeted adjuvant therapies.