Pembrolizumab Controlled Metastatic Pleomorphic Lung Cancer After Chemotherapy Failed
This lung cancer diagnosis at a glance
- Stage at diagnosis
- Stage IV
- Biomarkers
- EGFR-negative; ALK-negative; ROS1-negative; BRAF-negative; PD-L1 TPS 60%-70%; BRCA2, RBM10, and TP53 mutations; tumor mutation burden 42 mutations/Mb; no actionable alteration.
- Sex
- Male
- Spread to
- right adrenal gland; left adrenal gland; bone
- Treatment
- surgery, chemotherapy, radiation and immunotherapy
- Outcome
- Responding Well
Treatment course, step by step
- The rapidly growing right adrenal metastasis was surgically removed.
- Four cycles of carboplatin and nab-paclitaxel were administered.
- Radiation delivered 30 Gy in 10 fractions to bone metastases after progression.
- Pembrolizumab 200 mg was started as monotherapy.
- Pembrolizumab remained ongoing at 12 months with tumor shrinkage.
What happened, in summary
A 49-year-old man sought care for breathlessness, palpitations, and fever. Imaging showed a right upper-lobe lung tumor and a rapidly enlarging right adrenal mass. The adrenal lesion was surgically removed, and pathology showed pleomorphic carcinoma. Further evaluation confirmed pleomorphic carcinoma of the lung, classified cT3N0M1b, stage IVA.
Although his performance status was good, the lung tumor grew quickly and a new metastasis appeared in the left adrenal gland. He received four cycles of carboplatin and nab-paclitaxel. The primary tumor progressed, and bone metastases then developed. Radiation to 30 Gy in 10 fractions was delivered to the bone lesions.
Testing found no EGFR, ALK, ROS1, or BRAF driver alteration. PD-L1 expression was high at 60% to 70%. Next-generation sequencing identified BRCA2, RBM10, and TP53 mutations but no actionable mutation, while tumor mutation burden was high at 42 mutations per megabase.
Pembrolizumab monotherapy was started at 200 mg. Assessment 11 months later showed a reduction in tumor diameter, and treatment was still continuing at 12 months. His disease had progressed on cytotoxic chemotherapy but then achieved sustained control with immune-checkpoint therapy.
Where this story comes from
This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full
How we source and attribute stories Accuracy and limitations
Collections this story belongs to
- Stage 4 Lung Cancer 384 stories
- Carboplatin for Stage 4 Lung Cancer 104 stories
- PD-L1 Positive Lung Cancer 21 stories
- Carboplatin for Lung Cancer 168 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