What happened, in summary

A 32-year-old man with no symptoms was evaluated after incidental lung nodules were found on a routine chest X-ray in November 2022. He had no comorbidities, only a 2 pack-year current-smoking history, and no special lung-cancer risk factors such as family history, occupational exposure, or environmental exposure. His CEA tumor marker was elevated at 8.49 ng/mL, while routine blood chemistry and pulmonary-function testing did not show significant abnormalities. Further evaluation led to a diagnosis of clinical stage T3N1M0, Stage IIIA non-small cell lung cancer with an ALK gene rearrangement. Because the cancer was locally advanced but potentially treatable with curative intent, the case was reviewed in a multidisciplinary discussion. The patient chose neoadjuvant brigatinib, a targeted therapy directed at ALK-rearranged lung cancer. Treatment substantially reduced the tumor size before surgery. He then underwent surgery with curative intent. Pathology after surgery showed a pathologic complete response, meaning no residual tumor cells were found in the resected tissue. This is an important distinction from a standard imaging response, because the pathologist did not identify remaining viable cancer in the surgical specimen. During 13 months of follow-up, he remained disease-free. His disease was locally advanced and node-positive but non-metastatic, so the treatment goal was to shrink the tumor and proceed to curative-intent surgery. Brigatinib is the only neoadjuvant systemic therapy named in his treatment sequence; chemotherapy and immunotherapy were not part of the preoperative plan. His lack of symptoms, normal pulmonary-function testing, and treatment response supported proceeding to the planned curative-intent operation after tumor shrinkage.