Case Study: Pathologic Complete Response After Triple-Induction Therapy for NSCLC

By: Vanessa A. Carter, BS
Posted: Thursday, May 23, 2024

In the Journal of Cardiothoracic Surgery, Isabelle Opitz, MD, of the University Hospital Zurich, and colleagues reported a case of a patient with stage IIIA non–small cell lung cancer (NSCLC) who received chemoradiotherapy and the immune checkpoint inhibitor pembrolizumab followed by a pneumonectomy. Although this patient achieved a pathologic complete response, a combination of four different treatments requires a good performance status and patient adherence, the investigators emphasized.

“The case demonstrates that the combination of neoadjuvant chemo-, radio-, and immunotherapy in advanced NSCLC may lead to a relevant downstaging and may enable an R0 resection of a borderline resectable tumor,” stated the study authors. “A triple-induction treatment may be a promising option for selected patients with locally advanced NSCLC and [a] good performance status.”

A 47-year-old male patient presented with minor hemoptysis and shortness of breath; he reported a smoking history of 70 pack-years. CT of the chest showed a large tumor of the left hilum with infiltration of surrounding tissues; a biopsy revealed squamous cell carcinoma. PD-L1 positivity was identified in 40% of tumor cells and 70% of tumor-infiltrating immune cells, but no malignancy or metastasis to the lymph nodes or the brain was detected. Induction concurrent radiochemotherapy was initiated and consisted of three carboplatin and paclitaxel cycles. Concurrent neoadjuvant radiotherapy included 50 Gy in 25 fractions of 2 Gy, 5 days a week.

CT after treatment revealed a partial morphologic response. The patient underwent four cycles of pembrolizumab because of his high PD-L1 expression; subsequent PET-CT restaging demonstrated a further reduction in tumor size. After the final immunotherapy cycle, the patient was admitted for surgical resection of the tumor. The central location of the tumor influenced an intrapericardial left-sided pneumonectomy followed by mediastinal lymphadenectomy.

A pathologic complete response was identified upon histology. The patient was discharged after an unremarkable recovery. There were no signs of relapse 24 months after surgery.

Disclosure: For full disclosures of the study authors, visit cardiothoracicsurgery.biomedcentral.com.

Journal of Cardiothoracic Surgery

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