A Complete Sustained Response of Advanced Non-Small-Cell Lung Cancer After Immune Checkpoint Inhibitor, Radiotherapy, and Chemotherapy

Abstract

Lung cancer is the leading cause of cancer-related mortality worldwide. The treatment of advanced lung cancer is improving with the development of new treatments like immune checkpoint inhibitors (ICIs) and various molecular targeted agents, which have extended overall survival (OS). However, complete remissions remain rare. The efficacy of chemotherapy is modest, which makes a complete sustained response very unlikely, especially when compared with more recent options.In this article, we report a stage IV non-small-cell lung cancer (SCLC) that achieved a complete response in 2018 with chemotherapy (cisplatin and paclitaxel) after pembrolizumab and after the patient had received radiotherapy for superior vena cava syndrome (SVCS). The patient remains in complete response as of October 2022. We hypothesized that the overlap between circulating anti-PD-1, radiotherapy, and cytotoxic agents could explain this outcome.

Lung cancer invading the superior vena cava – surgical treatment. A short and up-to-date review

“…When administered as first-line therapy for patients whose tumors express PD-L1 on at least 50% of cells, ICIs improve overall survival compared to chemotherapy [ 12 ]. Moreover, ICIs plus chemotherapy have been shown to increase patient survival in both squamous and non-squamous types of NSCLC [ 13 , 14 ]. However, complete remissions remain rare [ 14 ].…”

“…Moreover, ICIs plus chemotherapy have been shown to increase patient survival in both squamous and non-squamous types of NSCLC [ 13 , 14 ]. However, complete remissions remain rare [ 14 ]. After progression under immunotherapy, several retrospective research and case reports show an unexpectedly positive response to chemotherapy.…”

“…After progression under immunotherapy, several retrospective research and case reports show an unexpectedly positive response to chemotherapy. In those trials, the idea that immunotherapy and chemotherapy had a synergistic impact was debated [ 14 , 15 ].…”