Pembrolizumab plus platinum-based chemotherapy for unfavorable cancer of unknown primary site: Case report

Autor: Norihiko Suzuki, Hideyuki Takeuchi, Junji Takahashi, Keigo Nakashima, Shinya Okada, Yutaka Suzuki, Hironori Ohdaira, Hiroshi Ishiguro, Teppei Kamada, Yuichi Nakaseko
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Oncology
medicine.medical_specialty
PD-L1
programmed death ligand 1
medicine.medical_treatment
NCCN
National Comprehensive Cancer Network
Case Report
Pembrolizumab
Pemetrexed
PET
positron emission tomography
Cancer of unknown primary
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Maintenance therapy
Internal medicine
medicine
Lung cancer
Platinum
Chemotherapy
LDH
lactate dehydrogenase
business.industry
ALK
anaplastic lymphoma kinase
CUP
cancer of unknown primary site
General Medicine
medicine.disease
TTF-1
thyroid transcription factor-1
Carboplatin
EGFR
epidermal growth factor receptor
CT
computed tomography
chemistry
030220 oncology & carcinogenesis
CR
complete response
Adenocarcinoma
030211 gastroenterology & hepatology
Surgery
CEA
carcinoembryonic antigen
business
CK7
cytokeratin 7
Non-small-cell lung cancer
Progressive disease
medicine.drug
Zdroj: Annals of Medicine and Surgery
ISSN: 2049-0801
Popis: Introduction 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. Case presentation 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. Discussion Chemotherapy with pembrolizumab, platinum and pemetrexed could be valuable for treating unfavorable CUP. Conclusion Chemotherapy with pembrolizumab, platinum, and pemetrexed helped achieved sustained complete response in a patient with unfavorable CUP.
Highlights • The prognosis of patients with unfavorable CUP remains poor. • Pembrolizumab's addition to standard chemotherapy resulted in significantly longer overall survival for patients with NSCLC. • Chemotherapy with pembrolizumab, platinum, and pemetrexed helped achieved sustained complete response in a patient with unfavorable CUP.
Databáze: OpenAIRE
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