Prolonged Survival in a Patient With Extensive-Stage Small Cell Lung Cancer in Spite of Discontinued Immunotherapy With Atezolizumab

Abstract

A 64-year-old man was referred from a local clinic with a chief complaint of cough. Computed tomography (CT) revealed a mass comprising a tumor in the right lower lobe and enlarged mediastinal lymph nodes, and a whole-body workup with positron emission tomography-CT showed bilateral lymph node enlargement and cancerous pericarditis. Biopsy with bronchoscopy of the right lower lobe tumor and mediastinal lymph node confirmed the histological findings of small cell lung carcinoma. The clinical diagnosis of extensive-stage small cell lung cancer (ES-SCLC) was confirmed, and first-line treatment with carboplatin, etoposide, and atezolizumab was initiated, followed by tri-weekly atezolizumab thrice. The patient experienced worsening pleural effusion treated with thoracentesis, pleural drainage, and pleurodesis. He also experienced several recurrences, which were managed with second and third-line chemotherapy with nogitecan and amrubicin. He has been receiving third-line therapy for over 30 months since his initial visit and remains stable as of today. The patient experienced an exceptional treatment outcome considering that the prognosis of ES-SCLC remains poor, with a median survival of approximately 10 months with conventional chemotherapies using cytotoxic agents. The use of immune checkpoint inhibitors (ICI) for ES-SCLC as first-line treatment may demonstrate a persistent antitumor effect, and result in improved survival following discontinuation. In conclusion, therapy including ICI for patients with ES-SCLC is a treatment option that shows possibilities in improving survival even after discontinuation.

Long-Term Survival and Stable Disease in a Patient with Extensive-Stage Small-Cell Lung Cancer after Treatment with Carboplatin, Etoposide and Atezolizumab

“…However, unlike our patient, this patient was continuously treated during periods of disease stability until progression. Konishi and colleagues reported a patient who received atezolizumab (along with etoposide plus platinum) for 6 months and was still alive 35 months later [ 13 ]. However, that patient received radiotherapy for chylothorax, followed by chemotherapy with nogitecan and then amrubicin after progression [ 13 ], whereas our patient received no further treatment after discontinuation of atezolizumab.…”

“…Konishi and colleagues reported a patient who received atezolizumab (along with etoposide plus platinum) for 6 months and was still alive 35 months later [ 13 ]. However, that patient received radiotherapy for chylothorax, followed by chemotherapy with nogitecan and then amrubicin after progression [ 13 ], whereas our patient received no further treatment after discontinuation of atezolizumab. Although the optimal duration of maintenance therapy with atezolizumab is not known, it is possible that our patient belongs to a subgroup of individuals in whom several months of such treatment results in sustained disease control.…”