How a Novel Combination of Immunotherapy and Chemotherapy Prolonged Life and Preserved Quality of Living

In the summer of 2019, a 58-year-old male patient in London, Ontario sought medical attention for a painless left-sided neck mass measuring 1.5 × 2.5 cm. Imaging and biopsy confirmed extensive-stage small cell lung cancer (ES-SCLC) with a primary tumor in the left lung base (2.8 × 3.4 cm) and multiple metastatic nodules across both lungs. Additional scans, including an MRI of the head and a PET scan, showed no intracranial metastases but confirmed spread to multiple cervical lymph nodes.

The patient began first-line palliative-intent induction therapy with carboplatin, etoposide, and atezolizumab from November 2019 to January 2020, completing four cycles. Aside from one hospital admission for febrile neutropenia, the regimen was well tolerated, and the patient reported improved function as the neck mass shrank. In February 2020, follow-up scans showed a partial response, leading to radiation therapy from March to April 2020 to the affected pulmonary sites and left neck. Maintenance atezolizumab was briefly paused during radiation but resumed afterward. The patient declined prophylactic cranial irradiation, opting for MRI surveillance instead.

By July 2020, routine imaging suggested mixed response, with some nodules decreasing but others growing. In August, disease progression was confirmed. Because the patient experienced a platinum-free interval of over six months, rechallenge with platinum-based chemotherapy plus atezolizumab began in October 2020. Six cycles were administered with dose adjustments due to anemia and mild fatigue. A March 2021 scan revealed further reduction or resolution of metastatic lesions.

Maintenance atezolizumab continued, reaching 72 total cycles to date. Side effects remained minimal, though the patient experienced osteonecrosis of the jaw related to long-term IV Zoledronate, and a temporary halt in atezolizumab due to transaminases, which resolved with oral steroids. Currently 63 years old, this patient maintains an ECOG performance status of 0, continues working with minor accommodations, and shows no signs of disease progression or new metastases.