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Abstract：
BACKGROUND: We report a case of sustained complete response in unfavorable cancer of unknown primary site (CUP) successfully treated with chemotherapy combining pembrolizumab, pemetrexed and platinum.
METHODS: A 66-year-old man was presented with weight loss and cough for 3 months. Contrast-enhanced computed tomography (CT) confirmed a mass in the superior anterior mediastinum and multiple enlarged mediastinal and axillary lymph nodes. Positron emission tomography-CT (PET-CT) showed abnormal uptake in the corresponding lesions. Histopathological analysis of the left axillary nodule revealed poorly differentiated adenocarcinoma. Immunohistochemistry showed the tumor cells were positive for cytokeratin 7 and thyroid transcription factor-1 and negative for cytokeratin 20. Thus, the patient was diagnosed as poorly differentiated adenocarcinoma of unknown primary, and treated as non-small-cell lung cancer. Additional genetic testing revealed the patient was negative for EGFR, ALK fluorescence in situ hybridization, ROS1, BRAF, and PD-L1 22C3 IHC with Tumor Proportion Score (TPS) was less than 1%. The patient received six cycles of pembrolizumab, platinum, and pemetrexed intravenously. Cisplatin was switched to carboplatin because of cisplatin nephrotoxicity in one course. PET-CT after six cycles showed all lesions disappeared; complete response was considered to have been achieved. Maintenance therapy of pembrolizumab and pemetrexed has been continued for 6 months after the induction therapies to prevent progressive disease. Complete response has been maintained.
CONCLUSIONS: Chemotherapy with pembrolizumab, platinum and pemetrexed could be valuable for treating unfavorable CUP.
CONCLUSIONS: Chemotherapy with pembrolizumab, platinum, and pemetrexed helped achieved sustained complete response in a patient with unfavorable CUP.
METHODS: A 66-year-old man was presented with weight loss and cough for 3 months. Contrast-enhanced computed tomography (CT) confirmed a mass in the superior anterior mediastinum and multiple enlarged mediastinal and axillary lymph nodes. Positron emission tomography-CT (PET-CT) showed abnormal uptake in the corresponding lesions. Histopathological analysis of the left axillary nodule revealed poorly differentiated adenocarcinoma. Immunohistochemistry showed the tumor cells were positive for cytokeratin 7 and thyroid transcription factor-1 and negative for cytokeratin 20. Thus, the patient was diagnosed as poorly differentiated adenocarcinoma of unknown primary, and treated as non-small-cell lung cancer. Additional genetic testing revealed the patient was negative for EGFR, ALK fluorescence in situ hybridization, ROS1, BRAF, and PD-L1 22C3 IHC with Tumor Proportion Score (TPS) was less than 1%. The patient received six cycles of pembrolizumab, platinum, and pemetrexed intravenously. Cisplatin was switched to carboplatin because of cisplatin nephrotoxicity in one course. PET-CT after six cycles showed all lesions disappeared; complete response was considered to have been achieved. Maintenance therapy of pembrolizumab and pemetrexed has been continued for 6 months after the induction therapies to prevent progressive disease. Complete response has been maintained.
CONCLUSIONS: Chemotherapy with pembrolizumab, platinum and pemetrexed could be valuable for treating unfavorable CUP.
CONCLUSIONS: Chemotherapy with pembrolizumab, platinum, and pemetrexed helped achieved sustained complete response in a patient with unfavorable CUP.
摘要：
■我们报告了一例原发灶未知的不良癌症（CUP），通过化疗联合派姆单抗成功治疗，培美曲塞和铂。
■一名66岁男子出现体重减轻和咳嗽3个月。对比增强计算机断层扫描（CT）证实上前纵隔肿块以及多个纵隔和腋窝淋巴结肿大。正电子发射断层扫描（PET-CT）显示相应病变的异常摄取。左腋窝结节的组织病理学分析显示低分化腺癌。免疫组织化学显示肿瘤细胞的细胞角蛋白7和甲状腺转录因子-1阳性，而细胞角蛋白20阴性。因此，患者被诊断为不明原发的低分化腺癌，治疗为非小细胞肺癌.额外的基因检测显示患者EGFR阴性，ALK荧光原位杂交,ROS1,BRAF,PD-L122C3IHC与肿瘤比例评分（TPS）小于1%。患者接受了六个周期的pembrolizumab，铂金,和培美曲塞静脉注射。在一个疗程中，由于顺铂的肾毒性，顺铂改用卡铂。六个周期后的PET-CT显示所有病变均消失；认为已达到完全反应。pembrolizumab和培美曲塞的维持治疗在诱导治疗后持续6个月以防止疾病进展。已保持完整的响应。
■pembrolizumab化疗，铂和培美曲塞可用于治疗不利的CUP。
■pembrolizumab化疗，铂金,和培美曲塞帮助CUP不良患者获得持续完全缓解。
■一名66岁男子出现体重减轻和咳嗽3个月。对比增强计算机断层扫描（CT）证实上前纵隔肿块以及多个纵隔和腋窝淋巴结肿大。正电子发射断层扫描（PET-CT）显示相应病变的异常摄取。左腋窝结节的组织病理学分析显示低分化腺癌。免疫组织化学显示肿瘤细胞的细胞角蛋白7和甲状腺转录因子-1阳性，而细胞角蛋白20阴性。因此，患者被诊断为不明原发的低分化腺癌，治疗为非小细胞肺癌.额外的基因检测显示患者EGFR阴性，ALK荧光原位杂交,ROS1,BRAF,PD-L122C3IHC与肿瘤比例评分（TPS）小于1%。患者接受了六个周期的pembrolizumab，铂金,和培美曲塞静脉注射。在一个疗程中，由于顺铂的肾毒性，顺铂改用卡铂。六个周期后的PET-CT显示所有病变均消失；认为已达到完全反应。pembrolizumab和培美曲塞的维持治疗在诱导治疗后持续6个月以防止疾病进展。已保持完整的响应。
■pembrolizumab化疗，铂和培美曲塞可用于治疗不利的CUP。
■pembrolizumab化疗，铂金,和培美曲塞帮助CUP不良患者获得持续完全缓解。
