Stage IV small-cell lung cancer: complete response after chemotherapy, radiotherapy, and immunotherapy

What happened, in summary

This 58-year-old woman was admitted in December 2015 after 2 months of repeated cough. Chest CT showed a right hilar mass with obstructive pneumonia, multiple right hilar and mediastinal lymph-node metastases involving the right main pulmonary artery, a small right pleural effusion, left pleural thickening, and a low-density liver lesion. Her NSE tumor marker was high at 79.39 ng/L, and bronchoscopy of the right middle lobe confirmed small-cell lung cancer. She received 6 cycles of etoposide plus cisplatin from December 2015 to April 2016, followed by intensity-modulated radiotherapy to the residual primary cavity, right hilum, and mediastinal lymph nodes from April to May 2016. One month after chemotherapy and radiotherapy, CT showed complete response of both the primary lung lesion and the hepatic metastases. She then had regular follow-up and remained well for several years. In May 2020, contrast-enhanced chest CT showed recurrence in the right lung, and tumor markers rose again, including ProGRP 1646.00 pg/mL. Because of cost constraints, she received 4 cycles of etoposide, cisplatin, and tislelizumab, followed by tislelizumab maintenance. The cancer responded, but in October 2020 she developed immune-related pancreatitis, with high amylase and lipase and abnormal pancreatic imaging. Tislelizumab was stopped, steroids were given, and pancreatic endoscopic cytology later found no malignant cells. She continued supportive pancreatic treatment for 18 months. By July 2021, pancreatic enzymes had normalized and chest CT showed complete response. This long first remission made the later recurrence clinically distinct from incomplete initial treatment. As of January 2, 2024, her overall survival exceeded 95 months.