Werner Raphael S, Lauk Olivia, Tscherry Georg, Curioni-Fontecedro Alessandra, Höller Sylvia, Opitz Isabelle
Department of Thoracic Surgery, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland.
Department of Oncology, Regional Hospital Uster, Brunnenstrasse 42, Uster, 8610, Switzerland.
J Cardiothorac Surg. 2024 Apr 15;19(1):207. doi: 10.1186/s13019-024-02759-y.
In patients with resectable stage III non-small cell lung cancer (NSCLC), induction chemoimmunotherapy followed by surgical resection has shown unprecedented rates of pathological response and event-free survival. However, a triple-induction including radiochemotherapy and immunotherapy followed by surgical resection has not been routinely established in clinical practice.
We report the case of a 47-year-old patient with stage IIIA NSCLC who was treated in a combined concept including induction concurrent radiochemotherapy, followed by 4 cycles of pembrolizumab and subsequent intrapericardial left-sided pneumonectomy. Histological analysis revealed a pathological complete response.
The case demonstrates that the combination of neoadjuvant chemo-, radio- and immunotherapy in advanced NSCLC may lead to a relevant down-staging and may enable a R0-resection of a borderline resectable tumor. However, the combination of four different treatment modalities requires resilience and a good performance status. A triple induction treatment may be a promising option for selected patients with locally advanced NSCLC and good performance status.
在可切除的Ⅲ期非小细胞肺癌（NSCLC）患者中，诱导化疗免疫治疗后行手术切除已显示出前所未有的病理缓解率和无事件生存率。然而，包括放化疗和免疫治疗在内的三联诱导治疗后行手术切除在临床实践中尚未常规确立。
我们报告了一例47岁的ⅢA期NSCLC患者，其接受了包括诱导同步放化疗、随后4个周期帕博利珠单抗治疗以及随后的心包内左侧肺切除术的联合治疗方案。组织学分析显示病理完全缓解。
该病例表明，晚期NSCLC新辅助化疗、放疗和免疫治疗的联合应用可能导致相关的降期，并可能实现对边界可切除肿瘤的R0切除。然而，四种不同治疗方式的联合需要患者有足够的恢复能力和良好的身体状况。三联诱导治疗可能是适合选定的局部晚期NSCLC且身体状况良好的患者的一种有前景的选择。
