A patient with metastatic non-small cell lung cancer who received pembrolizumab monotherapy after stereotactic body radiotherapy had progression-free survival of nearly 5 years: a case report

Abstract

Lung cancer is a malignancy with the highest morbidity and mortality in the world.Radiotherapy, chemotherapy, targeted therapy, and immunotherapy have been widely used to treat metastatic non-small cell lung cancer (NSCLC). Stereotactic body radiotherapy (SBRT), also known as stereotactic ablation radiotherapy (SABR), can precisely deliver a high dose of radiation to a target in a limited area.SBRT has been established as the standard treatment for patients with early NSCLC who are unsuitable for operation or refuse surgery and patients with oligometastatic NSCLC who are not suitable for surgery. As an immunologic agent, pembrolizumab has been approved to treat metastatic NSCLC in certain countries, including China and the United States. Increased tumor proportion score (TPS) can reduce pembrolizumab's immunotherapeutic effect, while SBRT can reduce TPS and enhance immunotherapy efficacy. However, there have been no reports in China on metastatic NSCLC patients who have received pembrolizumab monotherapy after stereotactic body radiotherapy (SBRT). Here, we present a case of progression-free survival (PFS) of nearly 5 years with pembrolizumab monotherapy after SBRT for metastatic NSCLC. This case is the patient with the most prolonged medication duration and who experienced the most efficacious treatment among the patients with metastatic NSCLC reported in the Chinese literature.

A Rare Case of Complete-Immunotherapy-Responsive Metastatic Non-Small Cell Lung Cancer with Long Lasting Progression-Free Survival: A Case Report

“…In the literature, cases with an overall survival (OS) exceeding 36 months are rare. A Chinese case report from 2021 [31] described a 78-year-old male patient with a history of prolonged tobacco abuse (20 cigarettes per day) and tuberculosis, diagnosed with NSCLC Stage T1N0M0, who underwent surgery and radiation therapy. After one year of radiation treatment, the patient developed lung, liver, cardiac, and bone metastases.…”

Immunotherapy Alone or in Combination with Stereotactic Body Radiotherapy in Advanced Lung Cancer: A Pooled Analysis of Randomized Clinical Trials

“…Exclusion criteria were ( 1 ) single-arm studies, ( 2 ) reviews/comments/letters, ( 3 ) meeting abstracts, ( 4 ) IT plus SBRT versus SBRT studies, ( 5 ) study protocols, ( 6 ) case reports, and ( 7 ) retrospective studies. Any disagreements were resolved by discussion.…”

“…In another phase 1 trial reported by Ye, the ORR was 39% and the median PFS was six months when advanced lung cancer patients were treated with IT plus SBRT ( 6 ). Moreover, several case studies indicated that some advanced patients achieved long-term survival after IT and SBRT ( 7 , 8 ).…”

The dynamic duo: A narrative review on the synergy between stereotactic body radiotherapy and immunotherapy in lung cancer treatment (Review)

“…On a side note, the duration of immunotherapy after SBRT is also an area with a paucity of research. A Chinese case study reported on a patient with 5 years of PFS following 52 months of extended pembrolizumab monotherapy after SBRT, representing the most prolonged medication duration with the best efficacy among Chinese patients in the literature ( 104 ), suggesting that the duration of ICI treatment may influence survival. The advent of precision medicine for NSCLC means translational research will now have a more important role to play in clinical trials than ever before.…”