Department of Clinical Investigation, National Hospital Organization Kochi Hospital, Kochi, Japan.
Department of Respiratory Medicine, Japanese Red Cross Kochi Hospital, Kochi, Japan.
Thorac Cancer. 2021 Jan;12(2):259-263. doi: 10.1111/1759-7714.13733. Epub 2020 Nov 10.
Complete response of non-small cell lung cancer (NSCLC) with immune checkpoint inhibitor (ICI) monotherapy is rare. Here, we encountered an elderly patient who showed complete response of NSCLC following treatment with pembrolizumab. An 84-year-old man with a history of bloody sputum for several weeks visited a general physician. At that time, a chest X-ray revealed a tumor shadow in the left middle lung field, and the patient was referred to our hospital. Following transbronchial biopsy, he was diagnosed with squamous cell carcinoma of the lung. Expression of programmed death ligand 1 (PD-L1) in tumor cells was 80% or more by immunostaining. Based on the above, immunotherapy with pembrolizumab was performed as first-line therapy. The cancer cells completely disappeared at the end of the fifth cycle. There were no side effects during the therapeutic course. Treatment with pembrolizumab continued for two years and was then discontinued at the patient's request. Since then, no tumor recurrence has been detected for about one and a half years without treatment. There have been few reports of lung cancer disappearing after treatment with pembrolizumab. In conclusion, in elderly NSCLC patients with PD-L1 expression of 50% or more, pembrolizumab should be considered as first-line treatment with the treatment period, and mechanism suggested in this report.
免疫检查点抑制剂 (ICI) 单药治疗的非小细胞肺癌 (NSCLC) 完全缓解罕见。在此，我们遇到了一位接受派姆单抗治疗后 NSCLC 完全缓解的老年患者。一位 84 岁的男性，有几周的咯血病史，前往全科医生就诊。当时，胸部 X 射线显示左肺中叶有肿瘤阴影，患者被转介到我们医院。经支气管镜活检后，他被诊断为肺鳞状细胞癌。肿瘤细胞的程序性死亡配体 1 (PD-L1) 表达通过免疫染色为 80%或更高。基于以上结果，采用派姆单抗进行免疫治疗作为一线治疗。第五个周期结束时，癌细胞完全消失。在治疗过程中没有副作用。派姆单抗治疗持续了两年，然后应患者要求停药。此后，在没有治疗的情况下，大约一年半没有发现肿瘤复发。在接受派姆单抗治疗后肺癌消失的报道很少。总之，对于 PD-L1 表达 50%或更高的老年 NSCLC 患者，应考虑将派姆单抗作为一线治疗，并考虑该报告中提出的治疗期和机制。
