PDF(Pubmed)
Abstract：
Small-cell lung cancer (SCLC) remains a disease with poor prognosis, particularly in extensive-stage SCLC (ES-SCLC). Current standard-of-care treatment includes chemotherapy with platinum agents and etoposide plus immunotherapy with atezolizumab or durvalumab, which has achieved a mean overall survival of 12-13 months in clinical trials. However, long-term survival in ES-SCLC, even with the addition of immunotherapy, continues to be rare. We present the case of a middle-aged male patient diagnosed with ES-SCLC who was treated with four cycles of induction chemotherapy (carboplatin and etoposide) and atezolizumab, starting maintenance atezolizumab every 21 days thereafter, and thoracic radiotherapy. After 9 months, he experienced mild disease progression and was rechallenged with six cycles of carboplatin and etoposide with continued atezolizumab. Subsequent imaging showed near-complete disease resolution which has been sustained since. He has continued on maintenance atezolizumab since diagnosis and has achieved 60 months overall survival and 44 months progression-free survival. Throughout treatment, he has maintained a high functional capacity and only experienced one immune-related adverse event. Our patient is representative of a small subset who are capable of achieving durable responses to immunotherapy and his case highlights the need for further research to elucidate the clinical and biological factors driving this response.
摘要：
小细胞肺癌（SCLC）仍然是一种预后不良的疾病，特别是在广泛阶段SCLC（ES-SCLC）。目前的标准治疗包括铂类药物化疗和依托泊苷+阿特珠单抗或durvalumab免疫治疗，在临床试验中，其平均总生存期为12-13个月。然而,ES-SCLC的长期生存，即使增加了免疫疗法，仍然是罕见的。我们介绍了一名诊断为ES-SCLC的中年男性患者，该患者接受了四个周期的诱导化疗（卡铂和依托泊苷）和阿特珠单抗治疗，此后每21天开始阿替珠单抗维持治疗，和胸部放疗。9个月后,他经历了轻微的疾病进展，并接受了6个周期的卡铂和依托泊苷治疗，并继续接受阿特珠单抗治疗。随后的成像显示几乎完全的疾病消退，此后一直持续。自诊断以来，他继续使用阿替珠单抗维持治疗，总生存期为60个月，无进展生存期为44个月。在整个治疗过程中,他保持了较高的功能能力，仅经历了一次与免疫相关的不良事件。我们的患者代表了能够实现对免疫疗法的持久反应的一小部分，他的病例强调需要进一步研究以阐明驱动这种反应的临床和生物学因素。
