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- Title
Impressive response on pembrolizumab monotherapy in a patient with metastatic NSCLC and multiple comorbidities: case report.
- Authors
Stolojanu, Anca-Alexandra; Dumitrescu, Elena-Adriana; Siminiceanu, Crina-Maria; Gheorghe, Adelina-Silvana; Ciontea, Loredana-Maria; Radu, Matei; Chirea, Irina-Alexandra; Bălașa, Mihai; Mihăilă, Raluca-Ioana; Kajanto, Lidia-Anca; Stănculeanu, Dana-Lucia
- Abstract
We present a case of a successful pembrolizumab monotherapy in a patient with metastatic non-squamous NSCLC (non-small cell lung carcinoma) and multiple comorbidities. The clinical treatment is challenging for elderly patients with lung cancer who cannot tolerate chemotherapy and do not have cancer driver genes. Evidence-based medicine supporting the use of immunotherapy for patients with ECOG PS≥2 is lacking, but this treatment option can be considered based on the PEPS2 trial. We report the case of a 72-year-old male patient diagnosed with metastatic lung adenocarcinoma after a transbronchial lung biopsy. The first imagistic evaluation disclosed hilar/mediastinal lymphadenopathy and proximal femur metastases. The patient was staged as pT4N3M1. He had a history of mixed ventilatory defect, congestive heart failure, bilateral pleural effusion and giant inguinal hernia. The immunohistochemistry results from the primary lung lesion were negative for EGFR and ALK. The PD-L1 expression level was 90% positive in the primary lung lesions (HIGH PDL-1). We determined that the patient was in a poor condition (ECOG PS 2), at risk for many complications and difficulties in tolerating chemotherapy. We administered pembrolizumab monotherapy at a dose of 200 mg every three weeks (26 cycles). For the first evaluation of efficacy, the next imagistic scan was done after nine cycles of treatment and exhibited an impressive response: dimensional regression of tumoral mass and hilar/mediastinal lymph nodes slightly smaller. In addition, the ECOG status improved and the patient achieved stable disease on the long term without obvious immune-related toxicity. In conclusion, this case illustrates the successful use of pembrolizumab as a first-line treatment in a 72-year-old patient with lung adenocarcinoma. Considering the need to balance the survival benefits with the quality of life and acknowledging that elderly patients show poor tolerance to chemotherapy, older patients without driving genes should be offered immune therapies when possible.
- Subjects
OLDER patients; LUNG diseases; CONGESTIVE heart failure; PEMBROLIZUMAB; NON-small-cell lung carcinoma; LYMPHADENITIS
- Publication
Oncolog-Hematolog, 2023, Issue 64, p48
- ISSN
2066-8716
- Publication type
Article