Narits Jaanika, Tamm Hannes, Jaal Jana
Department of Hematology and Oncology, University of Tartu, Tartu, Estonia.
Pathology Service, Tartu University Hospital, Tartu, Estonia.
Clin Transl Radiat Oncol. 2020 Apr 7;22:83-87. doi: 10.1016/j.ctro.2020.04.003. eCollection 2020 May.
We report on a 67-year old male with advanced stage lung adenocarcinoma (initially PD-L1 negative, EGFR and ALK negative) diagnosed in 2014. The patient received 4 lines of palliative chemotherapy from 2014 to 2017, however the disease progressed. In 2015, he also received palliative hypofractionated radiotherapy to a mediastinal mass, which was causing discomfort and pain. Since there was some data, that radiotherapy could induce PD-L1 expression, a new biopsy was taken in 2017 from the irradiated mediastinal mass. Subsequent pathologic report revealed that PD-L1 status was turned to be highly positive, with tumor proportion score of 100%. Similar high expression of PD-L1 was detected in a new metastasis in the duodenum, which was excised due to a duodenal perforation in 2017. From October 2017 to October 2019, the patient had 2-years of treatment (32 courses) with pembrolizumab and has had a positive effect (partial response) on all the lesions and following stabilization of the disease. Currently, this patient is under follow up and he is in a good condition without any complaints. Last CT-scan in March 2020 showed persisting partial response.
我们报告一例2014年确诊的晚期肺腺癌男性患者（初始PD-L1阴性，EGFR和ALK阴性），67岁。该患者在2014年至2017年期间接受了4线姑息化疗，但疾病仍进展。2015年，他还接受了针对纵隔肿块的姑息性大分割放疗，该肿块引起不适和疼痛。由于有一些数据表明放疗可诱导PD-L1表达，2017年从接受过放疗的纵隔肿块处重新进行了活检。随后的病理报告显示，PD-L1状态转为高度阳性，肿瘤比例评分达100%。在2017年因十二指肠穿孔而切除的十二指肠新转移灶中也检测到类似的PD-L1高表达。从2017年10月至2019年10月，该患者接受了2年（32个疗程）的帕博利珠单抗治疗，对所有病灶均产生了积极效果（部分缓解），随后疾病稳定。目前，该患者正在接受随访，状况良好，无任何不适。2020年3月的最后一次CT扫描显示持续部分缓解。
