Abstract Background: The ALINA study demonstrated that ALK inhibitors significantly improved survival in patients with early stage NSCLC. However, there are still many unanswered questions, such as what is the treatment paradigm for ALK + early NSCLC and what is the survival outcome in the real world. Methods: This study collected and analyzed the perioperative clinical treatment patterns and survival outcome data of patients with ALK + non-small cell lung cancer (NSCLC) who were diagnosed with stage IB-IIIA (AJCC Version 7) and underwent complete surgical resection since 2013 to reveal the real-world treatment patterns and survival of these patients. We also performed ctDNA MRD detection on the tissues and blood samples of patients receiving adjuvant targeted therapy to explore its predictive effect on the efficacy of patients with ALK + early NSCLC. Results: From 2013 to 2025, 206 patients with ALK + Stage IB-IIIA NSCLC were enrolled, of whom 156(75.7%) underwent curative resection. Of the patients who underwent curative surgery, 143(91.7%) received perioperative treatment, including chemotherapy (with or without immunotherapy) 87(60.8%), targeted therapy 25(17.5%), and chemotherapy plus targeted therapy 31(21.7%). The median time from diagnosis to disease recurrence was 36 months, 90 months, 90 months, and 30 months in the population who received perioperative chemotherapy, targeted therapy, chemotherapy plus targeted therapy, and did not receive any perioperative therapy, respectively. In addition, ctDNA MRD was tested in 14 patients who received postoperative adjuvant targeted therapy, MRD was positive in 9 patients before targeted adjuvant therapy and became negative in 3 patients after one month of targeted adjuvant therapy. Conclusions: In the real-world setting, perioperative targeted therapy for patients with ALK + Stage IB-IIIA NSCLC prolongs survival. Citation Format: Haiyong Wang, Shanshan Du. Real-world treatment patterns and survival in ALK+ early NSCLC abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C070.
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