Pleomorphic Lung Cancer Progressed Despite Pembrolizumab
This lung cancer diagnosis at a glance
- Stage at diagnosis
- Stage IV
- Biomarkers
- EGFR-negative; ALK-negative; ROS1-negative; PD-L1 TPS 80%-90%.
- Sex
- Male
- Spread to
- small intestine; pleura; abdominal subcutaneous tissue
- Treatment
- surgery, radiation and immunotherapy
- Outcome
- In Memory
Treatment course, step by step
- Left lower lobectomy and resection of the affected small-intestinal segment were performed for obstructive pneumonia and ileus.
- Radiation delivered 45 Gy in 25 fractions to an abdominal subcutaneous metastasis.
- Pembrolizumab 200 mg was started as monotherapy.
- Pembrolizumab was stopped after no response was seen following two cycles.
What happened, in summary
A 73-year-old man was referred with tumors in the left lower lung and small intestine. His performance status was initially good, but obstructive pneumonia and bowel obstruction developed during evaluation. He underwent resection of the left lower lobe and the affected segment of small intestine.
Pathology showed pleomorphic carcinoma arising in the lung with small-intestinal metastasis. The cancer was classified cT4N0M1a, stage IVA. Testing found no EGFR, ALK, or ROS1 driver alteration. PD-L1 expression was high, with a tumor proportion score of 80% to 90%.
After surgery, the disease continued to spread. Pleural dissemination and an abdominal subcutaneous metastasis became visible. The abdominal lesion was treated with radiation to 45 Gy in 25 fractions, and pembrolizumab monotherapy was started at 200 mg.
Assessment after two cycles showed no treatment response. Despite the high PD-L1 result, the aggressive pleomorphic carcinoma continued to progress. He died four months after pembrolizumab was initiated. Despite strong PD-L1 expression, pembrolizumab did not control his rapidly progressing cancer.
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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Collections this story belongs to
- Stage 4 Lung Cancer 384 stories
- Immunotherapy for Stage 4 Lung Cancer 146 stories
- PD-L1 Positive Lung Cancer 21 stories
- Immunotherapy for Lung Cancer 237 stories
These are lay summaries of published cancer stories, for information only. No two cancers behave the same way, and nothing here predicts your own diagnosis or replaces advice from your oncology team. Read the full disclaimer