Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Gifu, Japan.
Department of Thoracic Surgery, Gifu Prefectural Tajimi Hospital, Gifu, Japan.
Thorac Cancer. 2019 May;10(5):1263-1266. doi: 10.1111/1759-7714.13029. Epub 2019 Mar 12.
Pulmonary pleomorphic carcinoma (PPC) is resistant to anticancer drug treatment, outcomes are poor, and no standard therapy has been established. High PD-L1 expression has been found in PPCs, suggesting the possible efficacy of an immune checkpoint inhibitor (ICI) in cancer immunotherapy; however, this approach requires further investigation through case accumulation. Herein, we report a case of rapid recurrence and progression of PPC early after surgery in a 70-year-old male ex-smoker. Surgery was performed for lung cancer of the right lower lobe, and a pathological examination indicated primary PPC with high PD-L1 expression (tumor proportion score: 90%). Because systemic metastasis recurred only six weeks after surgery, nivolumab was administered as second-line treatment. Marked tumor regression was observed on imaging after three cycles, revealing a near complete response. Palliative radiotherapy was applied to the bone metastasis region for pain relief before nivolumab was administered. This case suggests that an ICI can have an effect on PPC and that the efficacy of ICIs may be enhanced by radiotherapy-induced abscopal effects.
肺多形性癌（PPC）对抗癌药物治疗具有耐药性，预后较差，且尚未确立标准治疗方法。在 PPC 中发现了高 PD-L1 表达，这表明免疫检查点抑制剂（ICI）在癌症免疫治疗中可能有效；然而，这种方法需要通过病例积累进一步研究。在此，我们报告了一例 70 岁男性吸烟患者手术后 PPC 早期快速复发和进展的病例。手术用于治疗右下叶肺癌，病理检查显示原发性 PPC 且 PD-L1 表达高（肿瘤比例评分：90%）。由于术后仅 6 周即出现全身转移，故给予nivolumab 作为二线治疗。在三个周期后，影像学观察到明显的肿瘤消退，几乎达到完全缓解。在给予 nivolumab 之前，对骨转移部位进行姑息性放疗以缓解疼痛。该病例提示 ICI 对 PPC 有效，并且放射治疗引起的远隔效应可能增强 ICI 的疗效。
