PMC8504157_01
Clinical response to long-term immunotherapy and the effect of surgery. (A) Schematics showing the time line of patient's diagnosis, treatment and response. (B) Computed tomography scans and Magnetic resonance imaging showing clinical response to immunotherapy and the effect of surgery. (C) The result of PD-L1 staining before immunotherapy. (D) PET-CT scan before Lung tumor resection. TC, paclitaxel+carboplatin; Pembro, pembrolizumab.
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Chest CT scanning found a right lung mass (about 10cm in diameter) ( Figures 1A, B ) and then the CT-guided percutaneous lung biopsy was performed, revealing a lung squamous cell carcinoma (LSCC). PD-L1 immunohistochemistry was performed using the Roche/Ventana anti-PD-L1 antibody SP142, revealing a negative PD-L1 expression ( Figure 1C ). The patient then started to receive paclitaxel+carboplatin+pembrolizumab from Dec 2017 and achieved partial response (PR) after receiving four cycles of treatment ( Figures 1A, B ). In May 2018, the patient suffered from a sudden speech disorder and brain MRI examination showed that the intracranial lesion was significantly enlarged, and then he underwent the supratentorial tumor resection in order to alleviate symptoms ( Figures 1A, B ). Chest CT showed that the size of lung lesion was further reduced ( Figure 1B ). Until Nov 2019, right lung lesion of the patient remained stable ( Figure 1B ). PET/CT scan indicated that there still existed residual metabolic-active areas within lung lesion without any other organ metastases ( Figure 1D ), while the plasma circulating tumor DNA (ctDNA) testing by (NGS) indicated a negative result. Although the patient didn't receive any treatment after surgery, no reoccurrence of tumor was found during a 1-year follow-up to Dec 2020 ( Figure 1B ).
Pathological results of postoperative specimens. (A) Hematoxylin-eosin staining of brain tumor tissue. (B) CK, CD4+ and CD8+ staining of brain tumor tissue. (C) HE, CD8+, Cytokeratin and CD68+ of lung tumor tissue. HE, Hematoxylin-eosin.
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The pathological diagnosis of brain tumor tissue showed necrotic foci and local tumor necrosis, which tended to be tumor infarction ( Figures 2A, B ). PS score=1).In order to eradicate lung cancer, the patient finally made the decision to undergo right lung middle lobe resection in Dec 2019. Pathological diagnosis of the lung lesion indicated that no residual tumor cells were found in resected tissue and most of the cells appeared to degenerate and die, with cholesterol crystal deposition, peripheral tissue cell aggregation and lymphocyte infiltration, which achieved a pCR ( Figure 2C ).