Abstract
BackgroundTracheobronchial malignant stenosis is a life-threatening condition which may cause recurrent infections due to lung atelectasis. Despite immunotherapy is less toxic than standard chemotherapy, recurrent lung infections may represent a challenge for this treatment.We report a clinical case of a patient with metastatic squamous cell carcinoma suffering from pulmonary infections due to central airway obstruction who underwent endoscopic recanalization followed by immunotherapy.Case presentationA 64 year-old man was referred to our attention for the management of metastatic squamous cell carcinoma obstructing the right main bronchus with recurrent pulmonary infections. Patient exhibited strong positive PD-L1 expression (> 50%). Advanced disease stage contraindicated surgical treatment. Although therapy with immune check point inhibitors was indicated as first-line treatment, recurrent pulmonary infections made it unfeasible. Therefore, we planned a combined approach including endoscopic recanalization of central airway in order to resolve lung atelectasis, and lung infection followed by immunotherapy treatment with pembrolizumab in order to avoid local and systemic disease progression.ConclusionsAt 16-week follow-up, the patient was alive in stable disease with improvement of clinical condition and no signs of lung infection.
Highlights
Recurrent pulmonary infections is a major challenge for Immune Checkpoint Inhibitors (ICIs) treatment in advanced lung cancer
The treatment of the present case was challenging due to the advanced stage of disease, and the poor clinical condition of the patient characterized by recurrent pulmonary infections, and severe respiratory distress due to central airway obstruction
We planned a new multimodal approach, not previously reported, which involved endoscopic central airway recanalization followed by ICI treatment with pembrolizumab
Summary
Introduction Recurrent pulmonary infections is a major challenge for Immune Checkpoint Inhibitors (ICIs) treatment in advanced lung cancer. Central airway malignant stenosis is a life-threatening condition which may cause severe respiratory distress and recurrent infections due to lung atelectasis [1].
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