Treatment with ensartinib improves postoperative survival in a patient with stage IIB LUAD carrying a rare ALK mutation: case report

Abstract A patient with stage IIB LUAD carrying a rare TOGARAM2-ALK mutation received long-term postoperative oral ensartinib therapy and showed no significant systemic progression or recurrence. A chest CT scan performed 3 days before admission revealed a 2.5 × 2.1 cm space-occupying lesion in the posterior segment of the right upper lobe, and thoracoscopic right upper lobectomy with mediastinal lymph node dissection was completed on the fourth day after admission. Postoperative pathology confirmed infiltrating adenocarcinoma in the right upper lobe of the lung, with predominant acinar growth, and additional papillary, micropapillary, and adherent components. The tumor measured 2.2 cm in diameter with evidence of airway spread, and right paratracheal lymph nodes showed metastatic involvement. Genetic testing detected a TOGARAM2-ALK (ch2:29244065) fusion mutation. The patient recovered well and was discharged after four postoperative days. During more than four years of follow-up, long-term ensartinib therapy was associated with stable disease without recurrence, offering potential clinical insights for managing LUAD with rare ALK variants.