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- Title
Fighting disease at 83 years old: SARS-CoV-2 survival and response to anti-PD-1 therapy in PD-L1 negative adenocarcinoma of the lung – case report.
- Authors
Nedelcu Rezumat (Chiurciu), Maria; Dragomir, Adelina Silvana; Mateianu, Elena Adriana; Stănculeanu, Dana Lucia
- Abstract
Background. During the novel coronavirus pandemic, the median overall survival of lung cancer patients has decreased from 7.9 months to 6.7 months. In the TERAVOLT analysis of patients with COVID-19 and thoracic cancers gathered from eight countries, 33% died and 76% needed hospital admission, with an age above 65 years old and presence of any comorbidities being negative prognostic factors. Lung cancer remains a leading cause of cancer-related death worldwide, despite the progress made with targeted therapies and immunotherapy. We present the case of an elderly patient diagnosed with metastatic pulmonary adenocarcinoma who, despite cardiovascular comorbidities and a negative expression of PD-L1, showed response to nivolumab (anti-PD-1) therapy and had a good clinical outcome after SARS-CoV-2 infection. Methodology. In January 2019, an 80-year-old female was diagnosed with acinar-predominant adenocarcinoma of the lung, stage IVA, with lung metastasis. She underwent surgical treatment, consisting of atypical resection of the left inferior lobe. The tumor tested negative for ALK/ EGFR mutations and PD-L1 expression. The patient had a history of treated thyroid neoplasm and several cardiovascular disorders. Due to her good performance status, she received first-line chemotherapy with a platinum-based regimen and bevacizumab for one year, until progression was noted following the imagistic evaluation by computed tomography (CT). Immunotherapy with nivolumab was started in February 2020. Results. Under nivolumab therapy, the tumor showed an initial pseudoprogression, followed by partial response, according to iRECIST criteria. The patient tolerated well the treatment. In December 2020, she tested positive for SARS-CoV-2 infection, with severe symptoms and CT findings of bilateral ground-glass opacities. After specific treatment, with favourable outcome, she was able to continue the nivolumab therapy. Discussion. Anti-PD-L1/PD-1 antibodies (e.g., nivolumab) act by binding on the programmed death-1 (PD-1) receptor found on T cells and blocking its interaction with its ligands, programmed death ligand 1 and 2 (PD-L1 and PD-L2). Those ligands mediate an inhibition of active T-cell proliferation and surveillance of tumors. Tumors can efficiently evade immune responses by expressing PD-L and activating this negative regulatory pathway. Although the expression of programmed death ligand 1 (PD-L1) on tumor cells is used in clinical practice as a predictive biomarker for the response to the therapy with anti-PD-L1/PD-1 antibodies, histopathological examinations revealed several examples of how PD-L1 expression can be a misleading marker. It is possible to have a good response to the aforementioned therapy in a PD-L1 negative patient or a lack of response in a PD-L1 positive one. Conclusions. This case illustrates the management of an elderly cancer patient with lung cancer and SARS-CoV-2 infection. The favourable response to nivolumab therapy reinforces the need for new biomarkers and more accurate testing assays in the clinical practice, in order to accurately predict the tumor response to anti-PD-1 antibodies.
- Subjects
PROGRAMMED death-ligand 1; COVID-19; TREATMENT effectiveness; T cell receptors; PROGNOSIS; CORONAVIRUS diseases
- Publication
Oncolog-Hematolog, 2022, Issue 58, p32
- ISSN
2066-8716
- Publication type
Article