Tailing effect of PD-1 antibody results in the eradication of unresectable multiple primary lung cancer presenting as ground-glass opacities: a case report

Abstract

There is currently no standard treatment for multiple primary lung cancer (MPLC). We report a case of synchronous MPLC presenting as one ground-glass opacity (GGO) with predominant consolidation accompanied by at least parietal pleura involvement, and another with >30 GGOs distributed across bilateral lungs, which was ineligible for complete resection. CT-guided percutaneous biopsy of the nearly pure-solid mass showed invasive lung adenocarcinoma mainly composed of acinar type. Capture-based, ultra-deep targeted sequencing (Burning Rock, Guangzhou, China) was performed on the tumor tissue biopsy. The result revealed no druggable mutations according to the guideline and a high TMB of 34.1 Mb. Immunohistochemical staining (22C3; Dako, Denmark) was positive for PD-L1 expression with a tumor expression level of 30%. Based on the clinical information and patient's decision, he received 3 cycles of pemetrexed plus pembrolizumab and was subsequently forced to withdraw due to acquired immune-related pneumonitis. After discontinuation of corticosteroids, he was subjected to wedge resection for the nearly pure-solid lesion, and then refused further treatment for the other tumors. After a follow-up of 12 months from termination of immunotherapy, almost all GGOs achieved radiographically complete remission, attributed to the tailing effect of the programmed cell death protein 1 (PD-1) antibody of pembrolizumab.Through the case study we found that unresectable synchronous MPLC presenting as GGOs may respond well to immunotherapy.

Investigation of the efficacy and safety of cryoablation and intra-arterial PD-1 inhibitor in patients with advanced disease not responding to checkpoint inhibitors: An exploratory study

“…Circulating CD4 + T-cell levels showed a peak and subsequent decline during the combination therapy but continued to increase in subsequent therapy cycles; this may be associated with tumour remission, which is consistent with the challenged tumour shrinkage 10 weeks after cryotherapy, as described in another article (36), and may also be a PD-1 trailing effect (37).…”

Recent Advances in the Diagnosis and Management of Multiple Primary Lung Cancer

“…GGNs are prone to contain driver oncogenes, which is an indicator of a low response rate to ICIs [ 83 ]. By contrast, other reports have shown promising results for ICIs application in the management of patients with MPLCs [ 84 , 85 ]. Zhang et al tested the efficacy of atezolizumab, an anti-PD-L1 agent, as neoadjuvant therapy in a patient with MPLC, and observed different treatment responses in each lesion [ 86 ].…”

Efficacy and safety of immune checkpoint inhibitors combined with chemotherapy as first-line treatment for extensive-stage small cell lung cancer: a meta-analysis based on mixed-effect models

“…One view is that immunotherapy has a unique mechanism of action in the anti-tumor process, which can initiate or restart the cancer-tumor cycle in patients, and amplify the immune effect, but not cause an unlimited autoimmune response. Based on this superiority of anti-tumor immune responses, immune memory may provide long-term immune protection, thereby enabling long-term survival ( 30 ). The smearing effect in the survival curves could be found in many clinical trials with immunotherapy.…”