Medicine · 2025
Preoperative selpercatinib induces major pathological response in a patient with stage IIIA, RET fusion-positive non-small cell lung cancer: A case report.
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Breitenecker Kristina, Fabikan Hannah, Weinlinger Christoph, Krenbek Dagmar, Klikovits Thomas, Watzka Stefan, Valipour Arschang, Hochmair Maximilian Johannes
Аннотация
RATIONALE: The success of tyrosine kinase inhibtors in the neoadjuvant and adjuvant setting provides a rationale for exploring selpercatinib in the perioperative setting to improve patient outcomes in early-stage lung cancer. However, selpercatinib is currently only approved as first-line treatment for advanced rearrangement during transfection (RET) fusion-positive non-small cell lung cancer (NSCLC), limiting its use and potential benefit for earlier stage patients. Hence, this case report explores selpercatinib's potential use in early-stage disease to address this treatment gap and improve patient outcomes.
PATIENT CONCERNS: We report the case of a 75-year-old female with no history of smoking who was referred to our institute with a chest computed tomography scan revealing a mass in the right lower lung lobe.
DIAGNOSES: The patient was diagnosed with RET fusion-positive lung adenocarcinoma based on findings from radiologic findings from computed tomography (CT) and positron emission tomography-CT scans, histopathological examination, and molecular profiling through next-generation sequencing.
INTERVENTIONS: The patient was treated with 4 cycles of carboplatin and pemetrexed. A follow-up CT scan revealed the progression of the mediastinal lymph node, leading to the decision to initiate selpercatinib treatment. Due to a major size reduction of the primary lesion and the absence of tumor cells in the lymph nodes, the patient underwent curative lobectomy and lymphadenectomy.
OUTCOMES: Preoperative selpercatinib induced tumor regression, enabling surgical resection. Histopathological examination of the resected tumor revealed a major pathological response to preoperative selpercatinib treatment.
LESSONS: This case highlights the potential of selpercatinib in the perioperative setting, suggesting that it induces tumor regression and enabling of curative surgery in early-stage RET fusion-positive NSCLC. Our findings support the further investigation of selpercatinib in early stages and provide a rationale for future treatment strategies of early-stage RET fusion-positive NSCLC patients.
PATIENT CONCERNS: We report the case of a 75-year-old female with no history of smoking who was referred to our institute with a chest computed tomography scan revealing a mass in the right lower lung lobe.
DIAGNOSES: The patient was diagnosed with RET fusion-positive lung adenocarcinoma based on findings from radiologic findings from computed tomography (CT) and positron emission tomography-CT scans, histopathological examination, and molecular profiling through next-generation sequencing.
INTERVENTIONS: The patient was treated with 4 cycles of carboplatin and pemetrexed. A follow-up CT scan revealed the progression of the mediastinal lymph node, leading to the decision to initiate selpercatinib treatment. Due to a major size reduction of the primary lesion and the absence of tumor cells in the lymph nodes, the patient underwent curative lobectomy and lymphadenectomy.
OUTCOMES: Preoperative selpercatinib induced tumor regression, enabling surgical resection. Histopathological examination of the resected tumor revealed a major pathological response to preoperative selpercatinib treatment.
LESSONS: This case highlights the potential of selpercatinib in the perioperative setting, suggesting that it induces tumor regression and enabling of curative surgery in early-stage RET fusion-positive NSCLC. Our findings support the further investigation of selpercatinib in early stages and provide a rationale for future treatment strategies of early-stage RET fusion-positive NSCLC patients.