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Published on: January 3, 2013
Case Report: PD-1 Inhibitor Is Active in Lung Adenocarcinoma With B Cell Deficiency
Shumin Yuan1, Xiufeng Hu2, Yanqiu Zhao2
1Department of Immunotherapy, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
Introduction:
In murine cancer models, B cells are unnecessary for efficacy of PD-1 inhibitor. However, we do not know whether this applies to clinical settings, especially in patients with non-small-cell lung carcinoma (NSCLC).
Case Presentation:
We report on the case of an advanced lung adenocarcinoma patient without oncogenic driver mutations whose disease progressed on second-line bevacizumab-containing chemotherapy regimens. These previous treatments resulted in profound thrombocytopenia and increased number of B cells; both effects were hard to alleviate. The patient was diagnosed with marginal zone B-cell lymphoma by flow cytometry immunophenotyping. After five cycles of rituximab in combination with lenalidomide treatment, the percentage of B cells rapidly declined to undetectable levels and the lymphoma regressed completely. However, because masses in the lung gradually increased, this patient was subsequently treated with a PD-1 inhibitor. The patient's condition stabilized, and the mass shrank to reach partial response, with progression free survival exceeding 15 months and no serious adverse events.
Conclusion:
The present case proves the efficacy of PD-1 inhibitor in metastatic lung adenocarcinoma in the absence of B cells. Immune checkpoint inhibitions are thus a choice for patients with B cell deficiencies, such as X-linked agammaglobulinemia, immunoglobulin deficiencies, and common variable immunodeficiency, diseases that have historically been excluded from clinical trials for oncologic drugs.
Insights
PD-1 inhibitors show efficacy in non-small-cell lung cancer patients even without B cells. This finding supports their use in patients with B cell deficiencies, expanding treatment options.
Area of Science:
- Immunology
- Oncology
- Medical Case Study
Background:
- B cells are considered unnecessary for PD-1 inhibitor efficacy in murine cancer models.
- The role of B cells in clinical settings, particularly in non-small-cell lung carcinoma (NSCLC), remains unclear.
Observation:
- A patient with advanced lung adenocarcinoma and no driver mutations experienced disease progression on chemotherapy.
- The patient developed B-cell lymphoma, treated successfully with rituximab and lenalidomide, leading to B-cell depletion.
- Following B-cell depletion, the patient received a PD-1 inhibitor for residual lung masses.
Findings:
- The PD-1 inhibitor treatment led to disease stabilization and partial response in the lung adenocarcinoma.
- Progression-free survival exceeded 15 months with no serious adverse events.
- This case demonstrates PD-1 inhibitor efficacy in a patient with B-cell deficiency.
Implications:
- PD-1 inhibitors can be effective for metastatic lung adenocarcinoma even in the absence of B cells.
- Immune checkpoint inhibitors may be a viable treatment option for patients with primary B cell deficiencies.
- This expands the potential eligibility for clinical trials and treatment for patients with historical B cell-related conditions.
