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Complete remission in an elderly patient with non-small cell lung cancer and brain metastasis using immunotherapy plus chemotherapy: a clinical case

https://doi.org/10.47093/2218-7332.2025.16.2.52-60

摘要

Lung cancer remains a leading cause of cancer-related mortality, with non-small cell lung cancer (NSCLC) accounting for the majority of cases. Among its subtypes, adenocarcinoma is most prevalent. Stage IV NSCLC comes with a poor prognosis, particularly in elderly patients with comorbidities. Programmed death-ligand 1 (PD-L1) checkpoint inhibitors have demonstrated promising efficacy, including in cases with brain metastases.
Case report. The case concerns an 83-year-old woman with diabetes mellitus, arterial hypertension, and atrial fibrillation, diagnosed with stage IVB poorly differentiated lung adenocarcinoma which was confirmed by a percutaneous lung biopsy. PD-L1 expression was 40%. Magnetic resonance imaging identified a solitary brain metastasis. The patient was treated with dexamethasone and a CheckMate 9LA protocol was initiated with reduced-dose carboplatin, pemetrexed, nivolumab, and ipilimumab. A two years follow-up positron emission tomography showed a significant reduction in lung cancer. The brain lesions had almost disappeared, and in addition a clinical improvement could be observed.
Discussion. This case underscores the potential for durable remission and improved quality of life through individualized treatment strategies in older patients with advanced NSCLC and brain involvement

关于作者

A. Chehal
Sheikh Shakhbout Medical City; Gulf Medical University
阿拉伯联合酋长国


A. ALakkad
Madinat Zayed Hospital
阿拉伯联合酋长国


H. Alkaabi
Sheikh Shakhbout Medical City
阿拉伯联合酋长国


A. Razek
Gulf International Cancer Center
阿拉伯联合酋长国


Y. Alabed
Gulf International Cancer Center
阿拉伯联合酋长国


H. Almasarei
Madinat Zayed Hospital
阿拉伯联合酋长国


参考

1. Rodríguez-Cid J.R., Chards S.C., González-Espinoza I.R., et al. A comparative study of immunotherapy as second-line treatment and beyond in patients with advanced non-small-cell lung carcinoma. Lung Cancer Manag. 2021 Mar 11; 10(3); LMT47. https://doi.org/10.2217/lmt-2020-0027. PMID: 34408789

2. Leone G.M., Candido S., Lavoro A., et al. Clinical relevance of targeted therapy and immune-checkpoint inhibition in lung cancer. Pharmaceutics. 2023 Apr; 15(4): 1252. https://doi.org/10.3390/pharmaceutics15041252. Epub 2023 Apr 16. PMID: 37111737

3. Chen P., Liu Y., Wen Y., et al. Non-small cell lung cancer in China. Cancer Commun (Lond). 2022 Oct; 42(10): 937-970. https://doi.org/10.1002/cac2.12359. Epub 2022 Sep 8. PMID: 36075878

4. Nicholson A.G., Tsao M.S., Beasley M.B., et al. The 2021 WHO classification of lung tumors: impact of advances since 2015. J Thorac Oncol. 2022 Mar; 17(3): 362–387. https://doi.org/10.1016/j.jtho.2021.11.003. Epub 2021 Nov 20. PMID: 34808341

5. Jiang K., Parker M., Materi J., et al. Epidemiology and survival outcomes of synchronous and metachronous brain metastases: a retrospective population-based study. Neurosurg Focus. 2023 Aug; 55(2): E3. https://doi.org/10.3171/2023.5.FOCUS23212. PMID: 37527669

6. Wang Q., Li J., Liang X., Zhan Q. Improved survival with surgical treatment of primary lung lesions in non-small cell lung cancer with brain metastases: a propensity-matched analysis of Surveillance, Epidemiology, and End Results database. Front Oncol. 2022 Jul; 12: 888999. https://doi.org/10.3389/fonc.2022.888999. PMID: 35936705

7. Schmidt M., Nitz U., Reimer T., et al. Adjuvant capecitabine versus nihil in older patients with node-positive/high-risk nodenegative early breast cancer receiving ibandronate – The ICE randomized clinical trial. Eur J Cancer. 2023 Nov; 194: 113324. https://doi.org/10.1016/j.ejca.2023.113324. Epub 2023 Sep 7. PMID: 37797387

8. Huang Q., Liu L., Xiao D., et al. CD44+ lung cancer stem cell-derived pericyte-like cells cause brain metastases through GPR124- enhanced trans-endothelial migration. Cancer Cell. 2023 Sep; 41(9): 1621–1636.e8. https://doi.org/10.1016/j.ccell.2023.07.012. Epub 2023 Aug 17. PMID: 37595587

9. Nishino M., Soejima K., Mitsudomi T., et al. Brain metastases in oncogene-driven non-small cell lung cancer. Transl Lung Cancer Res. 2019 Nov; 8(Suppl 3): S298–S307. https://doi.org/10.21037/tlcr.2019.05.15. PMID: 31857953

10. Sun C., Zhou F., Li X., et al. PD-1/PD-L1 inhibitor combined with chemotherapy can improve the survival of non-small cell lung cancer patients with brain metastases. Onco Targets Ther. 2020 Dec; 13: 12777–12786. https://doi.org/10.2147/OTT.S286600. PMID: 33363383

11. Reck M., Ciuleanu T.E., Cobo M., et al. First-line nivolumab plus ipilimumab with two cycles of chemotherapy versus chemotherapy alone (four cycles) in advanced non-small-cell lung cancer: CheckMate 9LA 2-year update. ESMO Open. 2021 Oct; 6(5): 100273. https://doi.org/10.1016/j.esmoop.2021.100273. Epub 2021 Oct 1. Erratum in: ESMO Open. 2021 Dec; 6(6): 100345. https://doi.org/10.1016/j.esmoop.2021.100345. PMID: 34607285

12. Tai Q., Zhang L., Hu X., et al. Clinical characteristics and treatments of large cell lung carcinoma: a retrospective study using SEER data. Transl Cancer Res. 2020 Mar; 9(3): 1455–1464. https://doi.org/10.21037/tcr.2020.01.40. PMID: 35117493

13. Zhang S. Diagnostic Imaging of Lung Cancers. Springer. 2024: 103–109. https://doi.org/10.1007/978-981-99-6815-2. ISBN978- 981-99-6814-5

14. Martin-Deleon R., Teixido C., Lucena C.M., et al. EBUS-TBNA cytological samples for comprehensive molecular testing in nonsmall cell lung cancer. Cancers (Basel). 2021 Apr; 13(9): 2084. https://doi.org/10.3390/cancers13092084. PMID: 33923116

15. Rodak O., Peris-Díaz M.D., Olbromski M., et al. Current landscape of non-small cell lung cancer: epidemiology, histological classification, targeted therapies, and immunotherapy. Cancers (Basel). 2021 Sep; 13(18): 4705. https://doi.org/10.3390/cancers13184705. PMID: 34572931

16. John T., Sakai H., Ikeda S., et al. First-line nivolumab plus ipilimumab combined with two cycles of chemotherapy in advanced non-small cell lung cancer: a subanalysis of Asian patients in CheckMate 9LA. Int J Clin Oncol. 2022 Apr; 27(4): 695–706. https://doi.org/10.1007/s10147-022-02120-0. Epub 2022 Feb 19. PMID: 35182247

17. Socha J., Rychter A., Kepka L., et al. Management of brain metastases in elderly patients with lung cancer. J Thorac Dis. 2021 May; 13(5): 3295–3307. https://doi.org/10.21037/jtd-2019-rbmlc-05. PMID: 34164222

18. Shalata W., Yakobson A., Dudnik Y., et al. Multi-center real-world outcomes of nivolumab plus ipilimumab and chemotherapy in patients with metastatic non-small-cell lung cancer. Biomedicines. 2023 Aug; 11(9): 2438. https://doi.org/10.3390/biomedicines11092438. PMID: 37760878

19. Saxena P., Singh P.K., Malik P.S., Singh N. Immunotherapy alone or in combination with chemotherapy as first-line treatment of non-small cell lung cancer. Cancer Treat Oncol. 2020 Jul 27;21(8):69. https://doi.org/10.1007/s11864-020-00768-2. Erratum in: Curr Treat Options Oncol. 2020 Sep 12;21(11):91. https://doi.org/10.1007/s11864-020-00789-x. PMID: 32720019

20. Shiravand Y., Khodadadi F., Kashani S.M.A., et al. Immune checkpoint inhibitors in cancer therapy. Curr Oncol. 2022 Apr; 29(5): 3044–3060. https://doi.org/10.3390/curroncol29050247. PMID: 35621637

21. Tawbi H.A., Forsyth P.A., Algazi A., et al. Combined nivolumab and ipilimumab in melanoma metastatic to the brain. N Engl J Med. 2018 Aug; 379(8): 722–730. https://doi.org/10.1056/NEJMoa1805453. PMID: 30134131


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Sechenov Medical Journal. Editor's checklist for this article you can find here.

 

 

Журнал «Сеченовский вестник»

 

Sechenov Medical Journal

Рецензии на рукопись

 

Peer-review reports

Название / Title

Полная ремиссия у пожилой пациентки с немелкоклеточным раком легкогои метастазом в головной мозг при лечении иммунотерапией ихимиотерапией: клинический случай / Complete remission in an elderly patient with non-small cell lung cancer and brain metastasis using immunotherapy plus chemotherapy: a clinical case

Раздел / Section

 

ОНКОЛОГИЯ/ONCOLOGY

 

Тип /

Article 

Клинический случай / Clinical case

 

Номер / Number

1192

 

Страна/территория / Country/Territory of origin

Объединенные Арабские Эмираты / United Arab Emirates

Язык / Language

Английский / English

 

Источник /

Manuscript source

Инициативная рукопись / Unsolicited manuscript

Дата поступления / Received

25.02.2025

Тип рецензирования / Type ofpeer-review

Двойное слепое / Double blind

Язык рецензирования / Peer-review language

Английский / English

 

 

 

 

 

РЕЦЕНЗЕНТ А / REVIEWER A

 

Инициалы / Initials

1192_А

 

Научная степень / Scientific degree

Кандидат медицинских наук / Cand. of Sci. (Medicine)

 

Страна/территория / Country/Territory

Россия / Russia

 

Дата рецензирования / Date of peer-review

21.04.2025

 

Число раундов рецензирования / Number of peer-review rounds

2

Финальное решение / Final decision 

принять к публикации / accept

 

 

 

ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW

 

This case report is a promising example of how personalized, multidisciplinary care can lead to remarkable outcomes in challenging clinical scenarios. The manuscript provides a well-rounded discussion of the role of immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC), particularly in the context of brain metastases. It references recent clinical trials and guidelines, supporting the use of ICIs in combination with chemotherapy.

However, there are some remarks regarding this work that could enhance readers' understanding.

  1. The article presents MRI images from 2022 and 2024 to demonstrate the reduction and resolution of the brain metastasis. However, there is a noticeable inconsistency in the slices shown for these two time points. The 2022 images clearly depict the metastasis in the left frontal lobe, while the 2024 images do not provide a direct comparison in the same plane or slice.
  2. The article includes many images related to lung examinations (CT and PET scans). While these images are valuable for illustrating the patient's response to treatment, their sheer volume may overwhelm readers and detract from the key findings.
  3. Many of these images could be consolidated or summarized in a single composite figure, highlighting the most critical changes over time. This would streamline the presentation and make it easier for readers to focus on the most relevant data.
  4. The article mentions improvement in the patient's psychological symptoms and personality but does not provide detailed information on her overall quality of life during and after treatment. This is an important consideration, especially in elderly patients with multiple comorbidities.
  5. The article could have discussed why radiation therapy was not pursued, especially given its traditional role in managing brain metastases. A brief explanation of the rationale for avoiding radiation would have been helpful.
  6. While the patient's survival is impressive, the article could have provided more context by comparing her outcome to historical data or clinical trial results for similar patients treated with standard therapies.

 

Recommendation after the first round of peer-review:   minor revision.

 

 

ВТОРОЙ РАУНД РЕЦЕНЗИРОВАНИЯ /SECOND ROUND OF PEER-REVIEW

 

Changes were made to the text, but there were still some shortcomings. MRI images of the brain for 2024 were not corrected. They must match the cross-sections made in 2022. It is possible to remove them completely, so it will be better.

 

 

 

 

 

РЕЦЕНЗЕНТ B / REVIEWER B

 

Инициалы / Initials

1192_В

 

Научная степень / Scientific degree

Доктор медицинских наук /

Dr. of Sci. (Medicine)

 

Страна/территория / Country/Territory

Россия / Russia

 

Дата рецензирования / Date of peer-review

02.04.2025

 

Число раундов рецензирования / Number of peer-review rounds

1

Финальное решение / Final decision 

Принять к публикации после небольшой доработки/ Minor revision

 

 

 

ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW

 

Scientific quality: Grade B: Good

Language quality: Grade B (Minor language polishing)

Re-review: No

 

The article submitted for review is a description of a clinical case, the relevance of which is associated with new data on the effectiveness of a certain chemotherapy regimen in a patient with non-small cell lung cancer. This clinical observation and its description do not contradict ethical standards. The materials and methods correspond to the stated goal. The conclusion is justified and corresponds to the obtained result. The terminology used in the text of the article is generally accepted. Literary sources are valid and correspond to the described clinical case. The text of the work does not require significant editing, the style of presentation and the level of English are satisfactory.

The authors should pay attention to the captions to the figures - the presented scans of computer tomograms are designated sagittal, while axial sections are depicted. After minimal editing the manuscript can be published.

 

 

 

 

 

РЕКОМЕНДАЦИИ НАУЧНЫХ РЕДАКТОРОВ ЖУРНАЛА / RECOMMENDATIONS

OF THE SCIENTIFIC EDITORS OF THE JOURNAL

 

Title

  1. Title should be no more than 150 characters with spaces. Avoid abbreviations in the title (such NSCLC, ICI).

 

Article highlights

  1. Add the ‘Article highlights’ section that contains 3 to 5 key messages.

 

Abstract

  1. Abstract should contain no more than 170 words. (Now the abstract has 262 words.)

 

Introduction

  1. Clearly define the aim of the clinical case. The aim should be placed in the end of ‘Introduction’ section.

 

The main text

  1. Add data regarding physical examination at admission:
    • Blood pressure
    • Heart rate, pulse
    • Blood glucose level or glycated hemoglobin
    • Respiratory rate
    • Blood oxygen saturation
    • Describe pain (constant or when breathing, visual analogue scale score)
  2. Add description of the tumor and metastasis (size and localization BEFORE AND AFTER treatment) in the main text, not only in figures description
  3. Add description of lymphatic nodes (size and localization BEFORE AND AFTER treatment) in the main text, not only in figures description
  4. As patient with diabetes and hypertension has taken dexamethasone and cardiotoxic medication, provide data regarding physical examination after two years of treatment (Blood pressure, Heart rate, pulse, Blood glucose level / glycated hemoglobin).

 

Figures

  1. Provide the same slices of the brain MRI.
  2. Provide ALL figures in separate files in high quality.
  3. Figures should be numbered in Arabic numerals, have a legend (Figure 1 … (the name)) and have a link in the text (fig. 1). Only one legend is provided for each multi-panel figure consisting of graphs that depicts data of the same theme (e.g., Figure 1 Magnetic resonance imaging of the brain. A: …; B: …).

 

Technical requirements

  1. Add information about all authors (full surname and name, academic degree and title (if any), position, place of work (or study), ORCID).
  2. For corresponding author provide full first and family (sur)names, abbreviated title (e.g., MD, PhD), affiliated institute’s name and complete postal address (including zip code).
  3. Specify authors’ contribution.
  4. Provide section ‘Financial support’.
  5. Provide ‘List of abbreviation’ before the main text.
  6. All abbreviations used in the article should be decrypted after they were firstly mentioned.

 

References

  1. In the text of the article, bibliographic references are given in Arabic numerals in square brackets (e.g., [1-3]).
  2. The ‘REFERENCES’ section lists the references in the Vancouver style. Check the authors guidelines on the Sechenov Medical Journal website:  https://www.sechenovmedj.com/jour/about/submissions#authorGuidelines
  3. Provide DOI and PMID for each reference. In case the reference has no DOI or PMID placed it in footnotes and removed from bibliography.
  4. The reference 6 should be placed in footnotes and removed from bibliography. Provide in footnotes the web-link and date of access.
  5. For reference 13 provide ISBN.
  6. The reference 14 should be placed in footnotes and removed from bibliography. Provide in footnotes the web-link and date of access.
  7. Provide journal name for references 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 15, 16, 17, 19, 20, 21, 22, 23.

 

 

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ISSN 2218-7332 (Print)
ISSN 2658-3348 (Online)

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