Hyperprogression on immunotherapy with complete response to chemotherapy in a NSCLC patient with high PD-L1 and STK11: A case report.
Hyperprogression on immunotherapy with complete response to chemotherapy in a NSCLC patient with high PD-L1 and STK11: A case report.
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DOI：
10.1097/md.0000000000022323
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发表时间：
2020-11-13
期刊：
影响因子：
1.6
通讯作者：
Salgia R
中科院分区：
文献类型：
--
作者：
Fricke J;Mambetsariev I;Pharaon R;Subbiah S;Rajurkar S;Salgia R
报告PD-L1高表达的患者对免疫治疗反应良好;然而，一些患者在开始免疫检查点抑制剂治疗后发生超进展性疾病。我们报告了1例PD-L1表达为100%的肺癌患者，在接受帕博利珠单抗治疗时发生了超进展性疾病，并对卡铂和培美曲塞的补救化疗反应良好。一名66岁的非裔美国女性，有25包年吸烟史、2型糖尿病、原发性血小板增多症和甲状腺乳头状癌病史，13个月后无疾病证据，发生复发性肺腺癌。监视影像示隆突下及肺门淋巴结肿大，经支气管镜证实为复发性肺腺癌。此外，脑部扫描显示左侧岛叶病变增强5 mm。 据报道，PD-L1表达率为100%。分期报告为IVB期TxN3M1c肺腺癌。将总剂量为20 Gray的一部分辐射输送到左侧岛叶病变。 患者开始帕博利珠单抗（200 mg）治疗，每3周一次。 然后，她接受了由卡铂（AUC 5）和培美曲塞（500 mg/m2）组成的挽救化疗，每3周一次，共3个周期。 放射治疗后，脑部病变消退。患者在接受2次帕博利珠单抗治疗后发生超进展伴大量心包积液和右侧胸腔积液。她的PD-L1表达在10周内从100%下降到0%。卡铂和培美曲塞挽救化疗持续20个月至出现疾病证据。免疫检查点通道相关的过度进展性疾病可能对二线挽救化疗有反应。在患者治疗后观察到完全PD-L1表达丧失，这可能是过度进展性疾病或肿瘤免疫逃避的标志物。
Patients reporting high PD-L1 expression have shown to respond well to immunotherapy; however, some patients develop hyperprogressive disease upon initiation of immune checkpoint inhibitors. We report a patient with lung cancer and 100% PD-L1 expression who developed hyperprogressive disease while treated with pembrolizumab and responded well to salvage chemotherapy with carboplatin and pemetrexed. A 66-year-old African American female with 25-pack year smoking history, diabetes mellitus type 2, essential thrombocytosis, and a history of papillary thyroid carcinoma developed relapsed lung adenocarcinoma after 13 months of no evidence of disease. Surveillance imagine showed subcarinal and hilar lymphadenopathy, which was confirmed as recurrent lung adenocarcinoma via bronchoscopy. In addition, a brain scan showed a 5 mm enhancing left insular lesion. PD-L1 was reported as 100% expression. Staging was reported as stage IVB TxN3M1c lung adenocarcinoma. One fraction of radiation with a total dose of 20 Gray was delivered to the left insular lesion. The patient initiated pembrolizumab (200 mg) every 3 weeks. She was then treated with salvage chemotherapy consisting of carboplatin (AUC 5) and pemetrexed (500 mg/m2) every 3 weeks for 3 cycles. The brain lesion resolved after the radiation therapy. The patient developed hyperprogression with a large pericardial effusion and right pleural effusion after 2 treatments of pembrolizumab. Her PD-L1 expression decreased from 100% to 0% over a 10-week period. Salvage chemotherapy with carboplatin and pemetrexed resulted with 20 months of ongoing to evidence of disease. Immune checkpoint inhibitor-related hyperprogressive disease may respond to second-line salvage chemotherapy. Complete PD-L1 expression loss was observed after the patient's treatment and could be a marker of hyperprogressive disease or tumor immunoevasion.