Abstract
Currently, immunotherapy has been a backbone in the treatment of advanced non-small cell lung cancer (NSCLC) without driver gene mutations. However, only a small proportion of NSCLC patients respond to immune checkpoint inhibitors, and majority of patients with initial response will develop acquired resistance at 5 years, which usually manifests as oligo-progression or oligo-metastases. Evidence from multiple clinical trials indicates that local consolidative therapies could improve the prognosis of oligometastatic NSCLC patients. Herein, we reported a case of advanced squamous lung cancer which showed a durable abscopal effect from microwave ablation after acquired resistance of immunotherapy.
Highlights
Lung cancer remains a malignant disease with high incidence and mortality [1]
We presented a successful case of a patient with advanced squamous cell lung cancer who showed an abscopal effect of local ablation
Emerging evidence demonstrated that locoregional therapies improved overall survival in oligo-progressive non-small cell lung cancer (NSCLC) patients and became a standard therapeutic strategy after resistance to molecular targeted therapy [6, 7]
Summary
Lung cancer remains a malignant disease with high incidence and mortality [1]. With the advent of immune checkpoint inhibitors, programmed cell-death protein 1 (PD-1) or programmed cell death 1 ligand 1 (PD-L1) blockade has become a backbone as first-line treatment, and a standard of care as second-line therapy for patients with advanced NSCLC and EGFR/ALK wildtype [2]. Locoregional therapies have been widely used to treat patients with oligo-progression or oligo-metastases and showed impressive outcomes in multiple solid tumors [4, 5] Among these local therapies, microwave ablation (MWA) is increasingly used in clinical practice due to its advantages of producing larger ablation zones over shorter periods of time. After four cycles the primary lung lesion was still not effectively controlled, and disease progression in the chest was confirmed by imaging (Figure 2A), and ECT bone scan revealed a new lesion in the right tibia, indicating the occurrence of bone metastases. Oligo-progression in the chest was found in August 2020, with enlarged primary lung lesion and mediastinal 4R/7 lymphadenopathy (Figure 2C) Given that this patient had severe COPD and could not tolerate radiotherapy in the lung and mediastinum simultaneously, CT-guided microwave ablation was utilized to eliminate the primary tumor in September 2020.
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