Official websites use. Share sensitive information only on official, secure websites. Correspondence to: Jamie E. Chaft, MD. Email: chaftj mskcc. The objective of this review is to summarize the literature regarding the prevalence and prognosis of early-stage ALK -positive NSCLC and the utility of targeted therapies, immunotherapy, and chemotherapy in the neoadjuvant and adjuvant settings. Last search was run on July 3, There were no language or time frame restrictions.
Studies on the prognostic impact of ALK in early-stage disease have had conflicting results. ALK TKIs are not approved in the neoadjuvant or adjuvant setting and there is a lack of large, randomized trial results.
Several trials are currently accruing but results are not expected for several years. Attempts at large, randomized trials to evaluate the benefit of ALK TKIs in the adjuvant and neoadjuvant has been hampered by slow recruitment given the rarity of ALK alterations, lack of universal genetic testing, and the rapid pace of drug development.
Expanded lung cancer screening recommendations, liberalization of surrogate endpoints i. Non-small cell lung cancer NSCLC remains the leading cause of cancer-related deaths with over two million new lung cancer cases per year globally 1. Comprehensive genomic sequencing has transformed the treatment of NSCLC, enabling the use of highly effective targeted therapies in the metastatic setting 3 - 6.
Use of an increasing number of ALK tyrosine kinase inhibitors TKIs has significantly improved outcomes for patients with metastatic ALK -positive NSCLC, and many of these patients will receive multiple lines of therapeutic ALK inhibition before being considered candidates for cytotoxic chemotherapy 9.
