Hyper-progressive disease after immune checkpoint inhibitor in SMARCA4-deficient small-cell lung carcinoma
Yosuke Chiba1, Toshinori Kawanami1, Kei Yamasaki1
1Department of Respiratory Medicine University of Occupational and Environmental Health Fukuoka Japan.
Abstract:
SMARCA4 (switch/sucrose non-fermentable-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4)-deficient thoracic tumours have shown poor prognosis in clinical settings. Although the optimal treatment for SMARCA4-deficient thoracic tumours remains unclear, existing studies indicate a favourable response of these tumours to immune checkpoint inhibitors (ICIs). However, there are no reports of fatality in SMARCA4-deficient small-cell lung carcinoma (SCLC) with hyper-progressive disease (HPD) upon treatment with ICIs. Herein, we report a patient with SMARCA4-deficient SCLC who had HPD after the first ICI treatment. A 35-year-old man was treated with nivolumab, subsequent to cytotoxic chemotherapy. A week after nivolumab initiation, chest computed tomography revealed marked increase in pleural effusion in the right lung and chest wall dissemination of the tumour, which concur with the definition of HPD. This is the first study to report the occurrence of HPD after treatment with ICIs in a patient with SMARCA4-deficient SCLC. Analysis of additional data is necessary to determine the optimal treatment for these patients.
Insights
SMARCA4-deficient small-cell lung cancer (SCLC) can experience hyperprogressive disease (HPD) after immune checkpoint inhibitor (ICI) therapy. This case report details the first occurrence of HPD in such a patient, highlighting a critical need for treatment research.
Area of Science:
- Oncology
- Genetics
- Immunotherapy
Background:
- SMARCA4-deficient thoracic tumors often present with poor prognosis.
- Existing research suggests these tumors may respond favorably to immune checkpoint inhibitors (ICIs).
- Hyperprogressive disease (HPD) following ICI treatment has not been previously reported in SMARCA4-deficient small-cell lung carcinoma (SCLC).
Observation:
- A 35-year-old male patient with SMARCA4-deficient SCLC received nivolumab after chemotherapy.
- One week post-nivolumab initiation, imaging revealed significant progression, meeting criteria for HPD.
Findings:
- This case represents the first documented instance of HPD after ICI treatment in a patient with SMARCA4-deficient SCLC.
- The patient experienced rapid disease progression, including increased pleural effusion and tumor dissemination.
Implications:
- The findings challenge the presumed efficacy of ICIs in all SMARCA4-deficient thoracic malignancies.
- Further research and data analysis are crucial to establish optimal treatment strategies for SMARCA4-deficient SCLC.
- This case underscores the potential for unexpected adverse events like HPD in specific cancer subtypes treated with immunotherapy.
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