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Published on: February 12, 2017
Response to toripalimab combined with radiotherapy in advanced non-small cell lung cancer-not otherwise specified: A
Yonglong Jin1, Wenjing Xiao1, Xintong Wang1
1Department of Radiotherapy, Affiliated Hospital of Qingdao University, Qingdao, China.
Rationale:
The targeting of signal transduction through programmed cell death receptor-1 (PD-1) and its ligand programmed cell death-ligand 1 (PD-L1) in patients with non-small cell lung cancer (NSCLC) has been widely applied in clinical research. However, the subtypes and treatment patterns that predict responses to PD-1/PD-L1 inhibitors are not fully understood. Biomarkers, such as PD-L1 expression, tumor mutation load, and DNA mismatch repair defects, have been used to screen patients who respond to PD-1/PD-L1 inhibitors, but the appropriate treatment mode requires further investigation. Immune checkpoint inhibitors combined with radiotherapy provide benefits from remote effects, especially in NSCLC patients with increased PD-L1 expression.
Patient Concerns:
We report a 64-year-old man who presented with left back pain for 40 days. A computed tomography scan showed a mass in the right upper lobe of the lung, with metastases in the right hilar and mediastinal lymph nodes.
Diagnosis:
NSCLC-not otherwise specified was diagnosed by computed tomography-guided lung biopsy.
Interventions:
After the failure of first-line chemotherapy, next-generation sequencing was performed for comprehensive gene analysis, and PD-L1 expression levels were evaluated by immunohistochemistry. The patient was treated with toripalimab (a PD-1 inhibitor) concurrently with radiotherapy for bone metastases.
Outcomes:
The detection results showed a high tumor mutation burden and increased PD-L1 expression. On the basis of these findings, the patient received toripalimab (PD-1 inhibitor) combined with radiotherapy for bone metastases. Partial response was achieved after 3 cycles, and the patient showed stable disease at the end of the sixth and ninth cycles of toripalimab. The patient was followed up for 26 months. At present, the patient is receiving toripalimab maintenance treatment, which has been well-tolerated without adverse events.
Lesson:
Toripalimab combined with radiotherapy may exert a synergistic anti-tumor effect through remote effects in advanced or metastatic NSCLC with high PD-L1 expression. However, the specific treatment mode requires further confirmation by the investigation of additional cases.
Insights
This study shows that combining toripalimab (a PD-1 inhibitor) with radiotherapy can effectively treat advanced non-small cell lung cancer (NSCLC) with high PD-L1 expression, leading to significant tumor response and long-term stability.
Area of Science:
- Oncology
- Immunotherapy
- Radiotherapy
Background:
- Programmed cell death receptor-1 (PD-1) and its ligand (PD-L1) pathway is a target in non-small cell lung cancer (NSCLC).
- Predictive biomarkers for PD-1/PD-L1 inhibitors in NSCLC are still under investigation.
- Combination therapies, including immune checkpoint inhibitors and radiotherapy, show promise for remote anti-tumor effects.
Observation:
- A 64-year-old male patient with non-small cell lung cancer (NSCLC) presented with lung mass and metastases.
- After first-line chemotherapy failure, the patient was found to have high tumor mutation burden and elevated PD-L1 expression.
Findings:
- The patient received concurrent toripalimab (a PD-1 inhibitor) and radiotherapy for bone metastases.
- Partial response was observed after 3 cycles, with stable disease maintained through 9 cycles and ongoing treatment for 26 months.
- The combination therapy was well-tolerated with no adverse events.
Implications:
- Toripalimab combined with radiotherapy may offer synergistic anti-tumor effects in advanced or metastatic NSCLC with high PD-L1 expression.
- This combination warrants further investigation in larger cohorts to confirm its efficacy and optimal treatment strategies.
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