Stage IV Squamous Lung Cancer Resected After Response to Checkpoint Immunotherapy

What happened, in summary

A 56-year-old man and former 60-pack-year smoker was diagnosed with Stage IV non-small cell lung cancer. He later received third-line anti-PD-1 immunotherapy. The treatment produced a marked radiographic response that lasted for about 1 year, although it also caused hypothyroidism. Immunotherapy was stopped when the cancer began progressing locally. PET imaging then showed residual disease limited to a 4.2 by 2.2 cm mass in the lingula and small mediastinal lymph nodes. Because the remaining disease appeared potentially removable, he was referred for surgery. He underwent an intrapericardial left upper lobectomy, resection of the phrenic nerve and lymph-node dissection. Pathology confirmed residual squamous cell carcinoma with mediastinal lymph-node involvement. His postoperative course was uncomplicated. He subsequently received mediastinal radiation. At postoperative follow-up, he remained alive, disease free and off treatment after surgery.