How Determination and Tailored Immunochemotherapy Led to Remarkable Progress

A 75-year-old patient, with a significant smoking history (30 pack-years), began experiencing reduced exercise tolerance, dyspnea on exertion, and periodic chest pain. Initially, the patient suspected a residual infection and used symptomatic medications without improvement. After noticing hemoptysis, antibiotic therapy was prescribed but yielded no change. Consequently, the patient was referred to the Department of Lung Diseases.

Preexisting conditions included chronic obstructive pulmonary disease (COPD), arterial hypertension, and ischemic heart disease. On admission, the patient’s blood pressure was elevated (160/90 mmHg), oxygen saturation was 95%, and bilateral lower limb edema and tachycardia were present. The ECOG Performance Status (PS) was recorded at 2, indicating substantial limitations in daily activity. Laboratory tests revealed increased inflammatory markers and elevated NT-proBNP.

Imaging studies showed a tumor in the right lung hilum with mediastinal lymphadenopathy and liver metastases, confirmed by CT. Bronchoscopy identified small cell lung cancer (SCLC), staged as cT4N2M1 (stage IV). Exacerbation of COPD and heart failure symptoms were managed with updated medication, including olodaterol + tiotropium, diuretics, and beta-blockers, followed by antibiotic therapy. After 10 days, the patient’s clinical condition improved, and ECOG PS improved to 1.

A multidisciplinary council chose combination immunochemotherapy: atezolizumab (1200 mg, day 1), etoposide (130 mg, days 1–3), and carboplatin (330 mg, day 1), administered every 21 days. Although the patient experienced anemia and thrombocytopenia after two cycles, follow-up CT scans showed a marked reduction in tumor size and no evidence of liver metastases. A 25% reduction in chemotherapeutic dose allowed treatment to continue, culminating in complete regression after four cycles. Mild skin rash was the only adverse effect.

Following initial success, maintenance therapy with atezolizumab alone led to disease progression after two cycles. Second-line topotecan was considered.