Spontaneous regression of ALK fusion protein-positive non-small cell lung carcinoma: a case report and review of the literature

Abstract

Background: ALK-rearrangement is observed in < 5% non-small cell lung cancer (NSCLC) cases and prior to the advent of oral tyrosine kinase inhibitors, the natural history of oncogenic NSCLC was typically poor. Literature relating to regression of treatment-naïve NSCLC is limited, and regression without treatment has not been noted in the ALK-rearranged sub-population. Case presentation: A 76 year old 'never smoker' female with an ALK-rearranged left upper lobe T2 N0 NSCLC experienced a stroke following elective DC cardioversion for new atrial fibrillation. Following a good recovery, updated imaging demonstrated complete regression of the left upper lobe lesion and a reduction of the previously documented mediastinal lymph node. Remaining atelectasis was non-avid on repeat PET-CT imaging, 8 months from the baseline PET-CT. When the patient developed new symptoms 6 months later a further PET-CT demonstrated FDG-avid local recurrence. She completed 55 Gy in 20 fractions but at 18 months post-radiotherapy there was radiological progression in the lungs with new pulmonary metastases and effusion and new bone metastases. Owing to poor performance status, she was not considered fit for targeted therapy and died 5 months later. Conclusion: All reported cases of spontaneous regression in lung cancer have been collated within. Documented precipitants of spontaneous regression across tumour types include biopsy and immune reconstitution; stroke has not been reported previously. The favourable response achieved with radical radiotherapy alone in this unusual case of indolent oncogenic NSCLC reinforces the applicability of radiotherapy in locally advanced ALK-rearranged tumours, in cases not behaving aggressively. As a common embolic event affecting the neurological and pulmonary vasculature is less likely, an immune-mediated mechanism may underpin the phenomenon described in this patient, implying that hitherto unharnessed principles of immuno-oncology may have relevance in oncogenic NSCLC. Alternatively, high electrical voltage applied percutaneously adjacent to the tumour during cardioversion in this patient may have induced local tumour cell lethality.

A very rare case of spontaneous regression of basaloid squamous cell carcinoma of the lung

“…SR of the non-small cell lung cancer is relatively rare and only 25 cases have previously been reported. 2 Most patients are of an advanced age, median age of 69 years. SR of basaloid squamous cell carcinoma has not previously been reported, and to the best of our knowledge this is the first report.…”

“…3 Most of the SR cancer reports consider the mechanism to be immunological, 3,4 and SR of tumors which are recognized for their immunogenicity such as melanoma, renal cell carcinoma and hematological cancers is relatively frequent. 2 Basaloid squamous cell carcinoma of the lung is a rare subtype of lung squamous cell carcinoma. It is an uncommon histological variant of lung cancer composed of cells exhibiting cytological and tissue architectural features of both squamous cell lung carcinoma and basal cell carcinoma, while the proportion of squamous cell components is less than 50%.…”

“…1 It occurs approximately once in every 60 000-100 000 cancer cases and most reported cases are melanoma, or hematological primaries, and are commonly attributed to the immune system. 2 Lung cancers undergo SR less frequently. 2 Herein, we present a very rare case of SR of basaloid squamous cell carcinoma of the lung, which to the best of our knowledge has not previously been reported in the literature.…”

“…2 Lung cancers undergo SR less frequently. 2 Herein, we present a very rare case of SR of basaloid squamous cell carcinoma of the lung, which to the best of our knowledge has not previously been reported in the literature.…”

Study on Effects of Cyclophosphamide Combined with Vinorelbine in Advanced Small Cell Lung Cancer and Anteroposterior Changes in MRI

“…To predict the effects of drug therapy as soon as possible, it is particularly important to adopt reasonable detection methods to adjust the later treatment plan for the prognosis of patients. MRI is less involved in the evaluation criteria of solid tumors, but recent literature has gradually emphasized the inspection potential of this technique for tumor patients [ 19 ]. MRI scanning can not only reflect tumor function information such as microvascular density, formation of tumor vessels, and surface permeability of capillary but also provides morphological images for better analyzing the physiological structure of tissues and characteristics of functional metabolism.…”