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Vol.63 No.2 contents | Japanese/English |
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- Case Report -
Continuous Treatment of Non-small-cell Lung Cancer with an Immune Checkpoint Inhibitor Followed by Resection of Recurrent Mediastinal Lymph Node Metastasis
Teppei Hashimoto1, Masaaki Inoue1, Yusuke Nabe1, Junichi Yoshida11Department of Thoracic Surgery, Shimonoseki City Hospital, Japan
Background. Immune checkpoint inhibitors (ICI) have contributed to major improvements in the antineoplastic treatment of non-small-cell lung cancer. However, studies have reported different patterns of response to programmed cell death protein 1 (PD-1) blockade among individual tumors. Case. A 66-year-old man was diagnosed with squamous cell carcinoma in the bilateral upper lobes (simultaneous multiple lung cancer). He underwent combination therapy consisting of ICI treatment and platinum-based chemotherapy (pembrolizumab+carboplatin+nab-paclitaxel). After four courses of therapy, computed tomography revealed a response in the bilateral tumors. After 23 courses of maintenance treatment with pembrolizumab, the tumor in the left upper lung remained undetectable, while that in the right upper lung had decreased in size. However, the right mediastinal lymph node (#4R) had increased in size. Images obtained via [18F]-fluorodeoxyglucose positron emission tomography/computed tomography revealed the accumulation of fluorodeoxyglucose at the same site, which we then diagnosed as mediastinal lymph node metastasis. Although the right hilar tumor remained, there was no obvious increase in size. Therefore, mediastinal lymph node resection was performed to control the disease and perform analyses for genetic mutations. Maintenance therapy with pembrolizumab was continued following the procedure. The patient's condition remains stable without exacerbation 1 year and 11 months after the diagnosis (4 months after surgery). Conclusion. The progression pattern as a response to PD-1 blockade across individual metastases in non-small-cell lung cancer is heterogeneous in some cases. For patients exhibiting local progression, surgical resection may aid in controlling the disease.
key words: Non-small-cell lung cancer, Programmed cell death protein 1, Immune checkpoint inhibitor, Pembrolizumab, Lung cancer
Received: May 11, 2022
Accepted: October 11, 2022
JJLC 63 (2): 95-100, 2023
