Neoadjuvant almonertinib as a bridging strategy to surgery in resectable lung cancer with active COVID-19: a case report

While surgical postponement is recommended for patients with resectable non-small cell lung cancer (NSCLC) and active COVID-19, safe and effective bridging therapies during the delay remain poorly defined, especially for epidermal growth factor receptor (EGFR)-mutant disease. We report a 71-year-old woman with resectable EGFR-mutant lung adenocarcinoma and concurrent active COVID-19 pneumonia. After multidisciplinary consensus, neoadjuvant almonertinib (110 mg daily) was administered as a bridging strategy. After 10 weeks, imaging showed significant tumor regression and complete resolution of pulmonary infiltrates. The patient subsequently underwent successful thoracoscopic radical resection. Pathological examination revealed less than 5% viable tumor cells, meeting criteria for major pathologic response (MPR). Adjuvant almonertinib was started on postoperative day 2. At 36-month follow-up, she remains disease-free with no significant treatment-related adverse events observed. This case demonstrates a potentially viable approach that warrants further investigation in this high-risk clinical scenario, offering a management template that simultaneously addresses infection resolution and tumor control to enable curative surgery.