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Abstract

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Article in Japanese

Case Report

Successful treatment with pembrolizumab of an elderly patient with advanced lung adenocarcinoma and poor performance status

Tsukasa Uedaa  Tomoyuki Arayaa  Yuka Uchidaa  Hideharu Kimurab  Kazuo Kasaharab  Toshiyuki Kitaa 

aDepartment of Respiratory Medicine, National Hospital Organization Kanazawa Medical Center
bDepartment of Respiratory Medicine, Kanazawa University Hospital

ABSTRACT

An 86-year-old woman was admitted to our hospital because of pain in the left iliac bone. Her whole-body computed tomography revealed left hilar lymphadenopathy, a mass on the right fifth rib, and osteolytic metastases on the left ilium. Microscopic findings in tumor samples from the left hilar lymph node obtained via endobronchial ultrasound-guided transbronchial needle aspiration revealed adenocarcinoma. She was accordingly diagnosed with lung adenocarcinoma (clinical stage IVB, T2bN1M1c) with multiple bone metastases. Molecular tests performed to detect driver mutations revealed a wild-type epidermal growth factor receptor and no anaplastic lymphoma kinase-1 or c-ros oncogene 1 translocations. The tumor proportion score for programmed death ligand 1 (PD-L1) of the tumor cells was 90%–100%. Although the patient had a performance status (PS) of 3, she wished to undergo active treatment. After receiving palliative radiotherapy for her left iliac bone metastasis, she received pembrolizumab as first-line treatment, having given fully informed consent. A partial response was observed after five cycles of pembrolizumab. Crucially, we were able to demonstrate the effectiveness of pembrolizumab as first-line treatment in a patient with non-small-cell lung cancer with a poor PS and high PD-L1 expression. To avoid missing an opportunity to treat such patients, the development of new biomarkers for detecting responders to cancer immunotherapy is required.

KEYWORDS

Pembrolizumab  Lung adenocarcinoma  Poor performance status (PS)  High PD-L1 expression 

Received 9 Aug 2018 / Accepted 30 Oct 2018

AJRS, 8(1): 26-30, 2019

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