Gao Pengqiang, Chen Hao, Zeng Taidui, Wu Weidong, Xu Guobing, Xu Chi, Zheng Bin, Zhu Yong, Zheng Wei, Chen Chun
Department of Thoracic Surgery, Fujian Medical Union Hospital, Fuzhou, China.
Transl Lung Cancer Res. 2020 Oct;9(5):2157-2160. doi: 10.21037/tlcr-20-770.
Lung cancer is the leading cause of cancer-related mortality worldwide. Patients with locally advanced non-small cell lung cancer (NSCLC) have lower overall survival. Studies have shown that some patients with unresectable stage III NSCLC develop disease progression after initial chemoradiotherapy, and new treatment is needed to improve the prognosis of these patients. The rapid development of therapy has greatly changed and continued to renew the treatment strategy of advanced NSCLC. However, the clinical treatment for patients with the wild-type gene remains problematic, and chemotherapy with platinum are not yet considered satisfactory. Herein, we are reporting a case of a patient with wild-type gene mutation locally advanced NSCLC who was treated with neoadjuvant therapy by using combined targeted anti-PD-1 immunotherapy and chemotherapy. The percentage of tumor cells with membranous PD-L1 staining (tumor proportion score) was 90% or greater. After receiving all three cycles of treatment, the patient underwent video-assisted right upper lung lobectomy and wedge resection plus radical mediastinal lymph node dissection. Pathological section samples showed a pathological complete response. This experience has led us to believe that the subgroup of patients with unresectable advanced NSCLC may benefit from this strategy and may have an opportunity for radical surgery.
肺癌是全球癌症相关死亡的主要原因。局部晚期非小细胞肺癌（NSCLC）患者的总生存率较低。研究表明，一些不可切除的III期NSCLC患者在初始放化疗后会出现疾病进展，需要新的治疗方法来改善这些患者的预后。治疗方法的快速发展极大地改变并持续更新了晚期NSCLC的治疗策略。然而，野生型基因患者的临床治疗仍然存在问题，铂类化疗尚未被认为令人满意。在此，我们报告一例野生型基因突变的局部晚期NSCLC患者，该患者接受了联合靶向抗PD-1免疫治疗和化疗的新辅助治疗。肿瘤细胞膜性PD-L1染色的百分比（肿瘤比例评分）为90%或更高。在接受了全部三个周期的治疗后，患者接受了电视辅助右上肺叶切除术和楔形切除术加根治性纵隔淋巴结清扫术。病理切片样本显示病理完全缓解。这一经验使我们相信，不可切除的晚期NSCLC患者亚组可能从该策略中获益，并可能有机会接受根治性手术。
