Single pembrolizumab treatment causing profound durable response in a patient with pulmonary pleomorphic carcinoma

Tokuyasu, Hirokazu; Ishikawa, Shota; Sakai, Hiromitsu; Ikeuchi, Tomoyuki; Miura, Hiroshi

doi:10.1016/j.rmcr.2019.100879

Cited by 11 publications

(9 citation statements)

References 34 publications

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“…To the best of our knowledge, a profound and durable response with a single dose of pembrolizumab in lung cancer is extremely rare. We could find only two previous case reports 2,3 . In each case, treatment was discontinued at one time because of a severe irAE.…”

Section: Discussionmentioning

confidence: 99%

“…One case was a myasthenic crisis 2 . Another was pneumonitis 3 . One patient received nivolumab and another patient received pembrolizumab.…”

Section: Discussionmentioning

confidence: 99%

“…We could find only two previous case reports. 2 , 3 In each case, treatment was discontinued at one time because of a severe irAE. Our case was grade‐3 immune‐related hepatitis.…”

Section: Discussionmentioning

confidence: 99%

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A single dose of pembrolizumab treatment causing a profound and durable response in lung cancer

et al. 2022

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Profound and durable responses to a single dose of pembrolizumab in lung cancer are rare. We encountered a non‐small cell lung cancer patient showing a deep and durable response with a single dose of pembrolizumab. A 79‐year‐old man reported bloody sputum for several weeks and visited a general physician. A chest x‐ray revealed a tumor shadow in the right middle lung field at that time, and the patient was referred to our hospital. He was diagnosed with adenocarcinoma of the lung by transbronchial biopsy. The expression of programmed death ligand 1 in tumor cells was 100% by immunostaining. Based on the above, immunotherapy with pembrolizumab was performed as first‐line therapy. Cancer cells had significantly shrunk at the end of the first cycle. The patient had grade‐3 immune‐related hepatitis at the end of the first cycle. Pembrolizumab treatment was stopped and prednisolone (80 mg/body) was initiated. Subsequently, liver function normalized, and prednisolone was tapered and discontinued. Since then, no tumor recurrence has been detected for 1.5 years without treatment. There have been few reports of profound and durable responses to a single dose of pembrolizumab in lung cancer. The results indicate that a single dose of pembrolizumab alone may be sufficient to cause durable response and serious immune‐related adverse events in some cases.

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Section: Discussionmentioning

confidence: 99%

“…One case was a myasthenic crisis 2 . Another was pneumonitis 3 . One patient received nivolumab and another patient received pembrolizumab.…”

Section: Discussionmentioning

confidence: 99%

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A single dose of pembrolizumab treatment causing a profound and durable response in lung cancer

et al. 2022

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“…Therefore, we adopted the treatment strategy of combination therapy to t the speci c needs of this patient. [24] 1 PPC, B PD-L1 (+), >50% pembrolizumab 2.5+ NA Tozuka (2018) [25] 1 PPC, IV PD-L1 (+), >50% pembrolizumab 5 NA Xiaofeng Li (2018) [26] 1 PSC, IV NA apatinib 14+ NA Hirokazu Tokuyasu (2019) [27] 1 PPC, IV PD-L1 (+), 100% pembrolizumab 17+ NA Vineeth Sukrithan (2019) [13] 5 PSC PD-L1 (+), >75% pembrolizumab 11+-29+ 14+-33+ Federica D'Antonio (2019) [28] 1 PSC, IV PD-L1 (+), >50% pembrolizumab 3 NA Emanuela Cimpeanu (2020) [29] 1 PSC, IIIA PD-L1 (+), >50% pembrolizumab 14+ NA Feng-Wei Kong (2020) [30] 3 PSC, III-IV PD-L1 (+) nab-paclitaxel+ carboplatin+ apatinib 6+,6+,7 NA Fengwei Kong (2020) [31] 1 PSC, IIIB PD-L1 (+) camrelizumab +doxorubicin 20+ NA Hirokazu Taniguchi (2021) [32] 1 In general, tumor growth and metastasis are dependent on neovascularization, and hypoxic-driven vascular endothelial growth factor (VEGF) is a major regulator of angiogenesis. The response to immunotherapy is associated with the immune invasion of tumor microenvironment (TME).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival of PD-1 Inhibitor Combined with Antiangiogenic Agents in a Patient with Pulmonary Sarcomatoid Carcinoma Complicated with Esophageal Cancer: A Case Resport and Literature Review

Jiao

Zhang

Zhu

et al. 2021

Preprint

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Pulmonary sarcomatoid carcinoma (PSC) is a highly aggressive rare subtype of non-small cell lung cancer (NSCLC). PSC is known for its poor prognosis and low sensitivity to conventional treatments such as chemotherapy, radiation, and adjuvant therapies. In recent years, the application of targeted therapy and immunotherapy in this field has made progress. Although programmed cell death 1 (PD-1) inhibitors have been reported to show favorable antitumor effects in PSC patients with high programmed death-ligand 1 (PD-L1) expression, the efficacy of PD-1 inhibitors in combination with antiangiogenic drugs has not been investigated. Here, we report for the first time a case of dual-source cancer with low expression of PD-L1 and microsatellite stability (MSS) which showed continuous response to sintilimab combined with anlotinib as first-line treatment and achieved a long progression free survival (PFS) of 24 months with no serious adverse reactions. This case presents a new therapeutic prospect for PSC and a potential to enhance its prognosis and treatment strategies.

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“… Age Sex CT Findings of the Lung Cancer (Maximum Diameter) Metastases Detected at Diagnosis Immunohistochemical Findings of PPC Treatments for PPC Survival (Months) Ref. 1 62 M A solitary mass (5.0 cm) ADR, OTH (pancreas, erector spinae muscle) PD-1+, PD-L1+ (clone 28–8, TPS 70%; clone 22C3, TPS 20%), p40-, TTF-1- CHEM followed by ICI >14 [ 15 ] 2 48 F A tumor (1.76 cm) BRA CK7+, PD-L1+ (TPS 80%), Vimentin+, TTF-1+ ICI followed by CHEM, RT 18 [ 16 ] 3 50 M A mass (3.7 cm) ADR, OTH (colon) CK7+, CK20-, SP-A+, TTF-1+ CHEM followed by ICI NA (died) [ 17 ] 4 73 M Multiple masses PUL, ADR PD-L1+ (TPS 80%) ICI >17 [ 18 ] 5 59 F A cavitary mass (6.0 cm) PUL, PLE, ADR, OSS AE1/AE3+, CAM5.2+, CK7+, CK20-, Napsin-A-, p40-, Vimentin+, TTF-1- None <1 (a few days) [ 19 ] 6 63 …”

Section: Case Presentationmentioning

confidence: 99%

Pulmonary Pleomorphic Carcinoma Mimicking Primary Sarcoma of the Neck: A Case Report and Literature Review

Ogawa¹,

Arahata

Kuriyama³

et al. 2021

CIA

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We describe our challenge in diagnosing an unusual and rapidly progressing case of pulmonary pleomorphic carcinoma (PPC)—a rare, poorly differentiated, or undifferentiated non-small-cell carcinoma that can metastasize locally or distantly and has a poor prognosis. Our patient was an elderly man with a one-month history of abdominal pain, anorexia, and weight loss, diagnosed with atrophic gastritis via endoscopy, and treated medically without improvement. A week later, this patient developed pain in the head, neck, and shoulder area, and further examination revealed a thickening of his left neck and shoulder, with no palpable lymph nodes. Computed tomography (CT) of the neck, chest, and abdomen led us to believe that we might be dealing with primary sarcoma of the neck since no lung mass was evident. Further investigation could not be performed because the patient’s status deteriorated rapidly. An autopsy revealed that soft tissue in the left neck and the mesentery was invaded by poorly differentiated polymorphic malignant cells, which were also seen in the lung lesion. Immunohistochemically, these malignant cells were all positive for AE1/AE3, CAM5.2, TTF-1, Napsin-A, and Vimentin. The cells were also positive for programmed death-ligand 1 staining with a low level of tumor proportion score (over 1%). The final diagnosis was PPC with metastases to soft tissues in the left neck and the mesentery. A review of previous case reports of PPC revealed that soft tissue is an uncommon site for metastasis, and that our CT findings were rather unusual. We hereby present our case and review of published case reports, with the hope that an awareness of the heterogeneous features of PPC could prompt timely biopsy and histological diagnosis.

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Single pembrolizumab treatment causing profound durable response in a patient with pulmonary pleomorphic carcinoma

Cited by 11 publications

References 34 publications

A single dose of pembrolizumab treatment causing a profound and durable response in lung cancer

A single dose of pembrolizumab treatment causing a profound and durable response in lung cancer

Long-Term Survival of PD-1 Inhibitor Combined with Antiangiogenic Agents in a Patient with Pulmonary Sarcomatoid Carcinoma Complicated with Esophageal Cancer: A Case Resport and Literature Review

Pulmonary Pleomorphic Carcinoma Mimicking Primary Sarcoma of the Neck: A Case Report and Literature Review

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