From Metabolic to Pathologic Complete Response: Case Report of Neoadjuvant Lorlatinib in Stage IIIB ALK-Positive NSCLC Combined with Uniportal VATS

While stage IIIB non-small cell lung cancer (NSCLC) is generally considered unresectable, a subset of patients may benefit from neoadjuvant therapy following comprehensive evaluation. We report a 35-year-old non-smoking female diagnosed with stage IIIB (cT1bN2bM0) adenocarcinoma of the left lower lobe with multiple-station mediastinal lymph node metastasis. Based on a multidisciplinary evaluation of multimodality imaging and genomic features of ALK-positive, the patient with high tumor-burden yet no significant comorbidities received neoadjuvant lorlatinib. The patient achieved a complete metabolic response on restaging PET-CT after 10 weeks of lorlatinib, which led to a multidisciplinary decision to undergo uniportal VATS lobectomy. Pathological examination confirmed a pathological complete response (pCR). Following a 5-day hospitalization without complications, the patient remains disease-free at the 12-month follow-up. To our knowledge, this is the first reported case of combining neoadjuvant lorlatinib and uniportal VATS to achieve pCR predicted by complete metabolic response in stage IIIB ALK-positive NSCLC.