Pulmonary large cell neuroendocrine cancer treated with airway procedures and pembrolizumab

This lung cancer diagnosis at a glance

Stage at diagnosis
Stage IV
Biomarkers
EGFR negative, ALK negative, ROS1 negative, TP53 negative, PD-L1 <1%, TMB 28.3 mut/Mb
Sex
Male
Spread to
bilateral lungs
Treatment
surgery, radiation and immunotherapy
Outcome
Setback / Progression

Treatment course, step by step

  1. Underwent bronchoscopic tumor ablation to reopen the right main bronchus.
  2. Received local radiation therapy.
  3. At recurrence, underwent repeat bronchoscopic ablation and photodynamic therapy, then started pembrolizumab.
  4. After complete remission, pembrolizumab maintenance continued.
  5. When lung metastases recurred, another airway ablation and photodynamic treatment were performed while pembrolizumab was maintained.

What happened, in summary

An 82-year-old man presented in 2019 with cough, shortness of breath and blood-streaked sputum. A tumor at the carina completely blocked the right main bronchus. Bronchoscopic ablation reopened the airway, and pathology showed pulmonary large cell neuroendocrine carcinoma.

Because his performance status made chemotherapy unsuitable, he received local radiation. Months later the airway tumor recurred and multiple nodules in both lungs were considered metastases. Repeat bronchoscopic ablation and photodynamic therapy were performed. Testing showed no EGFR, ALK, ROS1 or TP53 mutation, PD-L1 below 1%, and a high tumor mutational burden.

He then started pembrolizumab. The lung metastases progressively shrank, and by October 2020 imaging and bronchoscopy showed complete remission. Pembrolizumab maintenance continued. In October 2021, multiple lung metastases appeared again after an 18-month progression-free interval. He underwent another round of local airway treatment while pembrolizumab was continued.

Where this story comes from

This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full

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