Second Department of Lung Diseases and Tuberculosis, Medical University of Białystok, Białystok, Poland.
Am J Case Rep. 2022 Aug 11;23:e936536. doi: 10.12659/AJCR.936536.
BACKGROUND Atezolizumab is an immune checkpoint inhibitor used as first-line treatment with carboplatin and etoposide chemotherapy for advanced small cell lung cancer. Immunochemotherapy treatment decisions can be affected by patients' physical ability. Because of the exclusion of patients with an Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥2 from clinical trials, treatment outcome evidence in this group is limited. CASE REPORT We present the case of a 75-year-old woman with an ECOG PS of 2 admitted with respiratory symptoms and diagnosed with advanced small-cell lung cancer. After managing exacerbation of COPD and decompensated heart failure, atezolizumab with carboplatin and etoposide was administered. After 2 cycles of immunochemotherapy, deterioration of health was observed, including anemia and thrombocytopenia. Because of the good response in imaging tests and restored balance of the patient condition, immunochemotherapy was continued. After 4 cycles of combined treatment, complete regression was achieved. No another adverse effects were observed. The patient was qualified for maintenance therapy with atezolizumab. In follow-up CT scan after 2 cycles of atezolizumab, progression was observed and patient was qualified for second-line treatment. CONCLUSIONS This report presents the case of an older patient with advanced small cell lung cancer and an ECOG status of 2 who responded to combined immunochemotherapy with atezolizumab, etoposide, and carboplatin. Adverse effects observed during immunotherapy were not a reason for discontinuation of the therapy. The assessment of the effectiveness of immunotherapy in patients with ECOG PS ³2 is difficult owing to the insufficient representation of this group in clinical trials.
阿替利珠单抗是一种免疫检查点抑制剂，与卡铂和依托泊苷化疗联合用于治疗晚期小细胞肺癌。免疫化疗的治疗决策可能会受到患者身体能力的影响。由于临床试验排除了东部肿瘤协作组体力状况（ECOG PS）≥2 的患者，因此该组的治疗结果证据有限。
我们报告了一例 75 岁女性患者，ECOG PS 为 2，因呼吸症状就诊并诊断为晚期小细胞肺癌。在管理好 COPD 恶化和心力衰竭失代偿后，给予阿替利珠单抗联合卡铂和依托泊苷治疗。在接受 2 个周期的免疫化疗后，观察到健康状况恶化，包括贫血和血小板减少。由于影像学检查显示良好的反应和患者病情的平衡恢复，免疫化疗得以继续。在联合治疗 4 个周期后，达到完全缓解。未观察到其他不良反应。患者有资格接受阿替利珠单抗维持治疗。在接受阿替利珠单抗 2 个周期后的 CT 扫描随访中，观察到进展，患者有资格接受二线治疗。
本报告介绍了一例晚期小细胞肺癌合并 ECOG 状态为 2 的老年患者，对阿替利珠单抗、依托泊苷和卡铂联合免疫化疗有反应。免疫治疗期间观察到的不良反应不是停止治疗的原因。由于临床试验中该组患者的代表性不足，因此评估 ECOG PS ≥2 的患者免疫治疗的有效性具有一定难度。
