PMC10424693_01
(A and B) Baseline CT images. The red arrow in figure A indicates tumors and the red arrow in figure B indicates lymph nodes. (C and D) Lung mass and nodal metastasis achieved PR after four cycles of AP (albumin paclitaxel 400 mg and carboplatin AUC 5) and sugemalimab 1200 mg. The red arrow in figure C indicates tumors and the red arrow in figure D indicates lymph nodes. (E and F) Lung mass achieved SD, and nodal metastasis achieved CR after five cycles of 1200 mg of sugemalimab. The red arrow in figure E indicates tumors and the red arrow in figure F indicates lymph nodes.
CMAR-15-803-g0001.jpg
PMC10424693_01_CMAR-15-803-g0001.jpg
f0001
Chest Hospital in March 2022 due to cough and expectoration for 1 month. Chest computed tomography (CT) revealed an irregular mass (3.5x3.6 cm) in the lower lobe of his right lung with intramediastinal lymph node metastasis (Figure 1A and B). April 2022 to 10 July 2022, the patient received four cycles of immunochemotherapy: sugemalimab 1200 mg ig d1, albumin paclitaxel 400 mg ig d1, and carboplatin area under the curve (AUC) 5 ig d1/q3w. After the patient received 4 cycles of treatment on July 10, 2022, chest CT showed significant remission compared with baseline CT (27 March 2022) and achieved a partial response (PR) according to the Response Evaluation Criteria in Solid Tumors 1.1 (Figure 1C). In addition, chest CT showed that the lymph nodes achieved complete response (CR) compared with baseline CT (Figure 1D). However, chest CT (3 November 2022) showed that the mass was slightly larger than the previous CT scan (12th, October 2022), and the lymph nodes were very significantly increased (Figures 1E, F and 3A, B), which was evaluated as progressive disease (PD).
(A) Microscopic appearances of the pulmonary tumor showed lung SCC (HE staining x100). (B-D) Immunohistochemical staining for P40(+), Syn (-) and CD56(-), which are the optimal immunohistochemical markers for SCC (HE staining x100). (E) Microscopic appearances showed transformed SCLC (HE staining x100). (F-H) Immunohistochemical staining for P40(-), Syn (+) and CD56(+), which are the optimal immunohistochemical markers for transformed SCLC (HE staining x100).
CMAR-15-803-g0002.jpg
PMC10424693_01_CMAR-15-803-g0002.jpg
f0002
On 8 April 2022, bronchoscopy was performed, and the pathological findings were compatible with lung SCC (Figure 2A). Immunohistochemical (IHC) staining was positive for P40 (Figure 2B) but negative for CD56 and synaptophysin (Figure 2C and D). The pathological diagnosis was small cell carcinoma (Figure 2E). Immunohistochemical (IHC) staining was positive for CD56 and synaptophysin but negative for P40 (Figure 2F-H).
(A and B) Lung mass and nodal metastasis were evaluated as PD compared with CT (12 October 2022). The red arrow in figure A indicates tumors and the red arrow in figure B indicates lymph nodes. (C and D) The lung mass achieved SD, and nodal metastasis achieved PD after two cycles of etoposide combined with cisplatin. The red arrow in figure C indicates tumors and the red arrow in figure D indicates lymph nodes.
CMAR-15-803-g0003.jpg
PMC10424693_01_CMAR-15-803-g0003.jpg
f0003
However, chest CT (3 November 2022) showed that the mass was slightly larger than the previous CT scan (12th, October 2022), and the lymph nodes were very significantly increased (Figures 1E, F and 3A, B), which was evaluated as progressive disease (PD). Subsequently, this patient was treated with 2 cycles of etoposide combined with cisplatin, and the CT scan showed sustained disease progression (Figure 3C and D).