Baba Shuhei, Kinoshita Fumihiko, Yamamoto Yoshihiro, Nakanishi Yoshiyuki, Akamine Takaki, Kohno Mikihiro, Ozono Keigo, Takenaka Tomoyoshi, Yoshizumi Tomoharu
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Thoracic Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Gen Thorac Cardiovasc Surg Cases. 2025 Feb 3;4(1):6. doi: 10.1186/s44215-025-00187-5.
Preoperative nivolumab combination chemotherapy has shown its efficacy in resectable stage II-III non-small cell lung cancer and become one of the standard treatments. While preoperative nivolumab combination chemotherapy is generally a regimen of three cycles, the efficacy of nivolumab combination chemotherapy when treatment is prematurely discontinued remains unclear.
An 81-year-old man was diagnosed as lung adenocarcinoma (cT3N1M0, cStage IIIA). A computed tomography (CT) showed a 58 mm mass in left upper lobe with an intrapulmonary metastasis, and a positron-emission tomography/CT suggested metastatic lymph nodes at the left pulmonary hilum. Preoperative nivolumab + carboplatin + paclitaxel were administered; however, after the first cycle, the treatment was discontinued due to grade 3 anorexia, grade 1 body weight loss, and grade 4 neutropenia. It was affair that continuation of preoperative therapy made him unsuitable for surgery, and CT scan showed a reduction in the tumor size to 20 mm. Then, we decided to discontinue the preoperative therapy and perform surgery. Video-assisted thoracoscopic left upper lobectomy and lymph node dissection were performed, and the postoperative course was uneventful. The pathological examination revealed 15% of residual tumor cell in primary lesion and no metastatic lymph nodes was diagnosed. The patient did not undergo adjuvant chemotherapy, and no recurrence was observed 1.5 years after surgery CONCLUSIONS: In this case, preoperative nivolumab combined chemotherapy was discontinued only one cycle due to adverse events; however, a significant treatment effect was achieved. Therefore, even it is unable to continue preoperative nivolumab combined therapy, it is important not to miss the chance of surgery, as good treatment effect may have been achieved.
术前纳武利尤单抗联合化疗已在可切除的II-III期非小细胞肺癌中显示出疗效，并成为标准治疗方法之一。虽然术前纳武利尤单抗联合化疗通常为三个周期的方案，但过早停药时纳武利尤单抗联合化疗的疗效仍不清楚。
一名81岁男性被诊断为肺腺癌（cT3N1M0，cIII A期）。计算机断层扫描（CT）显示左上叶有一个58毫米的肿块，伴有肺内转移，正电子发射断层扫描/CT显示左肺门有转移性淋巴结。给予术前纳武利尤单抗+卡铂+紫杉醇治疗；然而，在第一个周期后，由于3级厌食、1级体重减轻和4级中性粒细胞减少而停止治疗。继续术前治疗会使他无法进行手术，CT扫描显示肿瘤大小缩小至20毫米。然后，我们决定停止术前治疗并进行手术。进行了电视辅助胸腔镜左上叶切除术和淋巴结清扫术，术后过程顺利。病理检查显示原发灶残留肿瘤细胞为15%，未诊断出转移性淋巴结。患者未接受辅助化疗，术后1.5年未观察到复发。
在本病例中，术前纳武利尤单抗联合化疗因不良事件仅进行了一个周期就停止了；然而，仍取得了显著的治疗效果。因此，即使无法继续术前纳武利尤单抗联合治疗，重要的是不要错过手术机会，因为可能已经取得了良好的治疗效果。
