Huang Fengxiang, Tang Jiaqi, Lou Jiaojiao, Wang Qilong, Ma Kai, Qiao Ruiping, Si Jiming, Kang Yan, Chen Hongjie, Mei Jingjing, Wang Huanqin, Liu Yuanhua, Miao Lijun
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Transl Cancer Res. 2022 Sep;11(9):3337-3342. doi: 10.21037/tcr-22-666.
Approximately 10-25% of patients with small cell lung cancer (SCLC) have brain metastases at the time of diagnosis. Radiotherapy is a common treatment for brain metastases, but the relapse rates are high. Accumulating evidence suggests that immunotherapy may have a better therapeutic effect for brain metastases. Here, we reported a patient with limited-stage SCLC and relapsed brain metastases who achieved sustained intracranial complete response (CR) to programmed cell death-1 (PD-1) inhibitor toripalimab and multikinase inhibitor anlotinib.
A 59-year-old female patient developed brain metastases after initial treatment for limited stage SCLC. CR of brain lesions was achieved after intensity-modulated radiation therapy followed by chemotherapy with irinotecan plus lobaplatin and concurrent anlotinib. PD-1 inhibitor sintilimab combined with anlotinib were given as maintenance therapy. Small and asymptomatic brain lesions relapsed 2.5 months after achieving CR. Another three cycles of sintilimab combined with anlotinib failed to control the relapsed brain lesions. Following two cycles of another PD-1 inhibitor toripalimab combined with anlotinib, the relapsed brain metastases disappeared. Then the patient received another seven cycles of this regimen with sustained CR, and no serious adverse reactions occurred. Interestingly, the primary lung tumor achieved sustained CR from the end of initial treatment to the last follow-up.
This case suggests that toripalimab in combination with anlotinib may be a promising treatment option for patients with brain metastases from SCLC.
约10%-25%的小细胞肺癌（SCLC）患者在诊断时已有脑转移。放射治疗是脑转移的常见治疗方法，但复发率很高。越来越多的证据表明，免疫治疗对脑转移可能具有更好的治疗效果。在此，我们报告了1例局限期SCLC并复发脑转移的患者，其对程序性细胞死亡蛋白1（PD-1）抑制剂托瑞帕利单抗和多激酶抑制剂安罗替尼获得了持续的颅内完全缓解（CR）。
1例59岁女性患者在局限期SCLC初始治疗后发生脑转移。在调强放射治疗后，序贯伊立替康联合洛铂化疗及同时使用安罗替尼，实现了脑病灶的CR。给予PD-1抑制剂信迪利单抗联合安罗替尼作为维持治疗。在达到CR后2.5个月，出现了小的无症状脑病灶复发。信迪利单抗联合安罗替尼的另外3个周期未能控制复发的脑病灶。在使用另一种PD-1抑制剂托瑞帕利单抗联合安罗替尼2个周期后，复发的脑转移灶消失。随后患者接受该方案的另外7个周期治疗，维持CR，且未发生严重不良反应。有趣的是，原发性肺肿瘤从初始治疗结束至最后一次随访一直维持CR。
该病例提示，托瑞帕利单抗联合安罗替尼可能是SCLC脑转移患者一种有前景的治疗选择。
