Immunotherapy with toripalimab for lung adenocarcinoma in a real-world patient with an Eastern Cooperative Oncology Group performance status (ECOG PS) score of 4: a case report.

Abstract

Multidisciplinary treatment, mainly chemotherapy combined with immunotherapy, is preferred in patients with advanced lung cancer who are negative for driver genes and have an Eastern Cooperative Oncology Group performance status (ECOG PS) score of 0-1; in contrast, patients with an ECOG PS score of 3-4 should be managed with supportive treatment and palliative care rather than chemotherapy or other antitumor treatments. In the real-world settings, however, in the Chinese population, a large proportion of patients and their families are willing to take risks to receive benefit from oncological treatments. We encountered a patient who had definite advanced lung adenocarcinoma with multiple metastases and fusion in abdominal lymph nodes. Intestinal obstruction and obstructive jaundice were also observed. Despite the application of gastrointestinal decompression, continuous parenteral nutrition support, common bile duct stenting, and pancreatic duct stenting, no effective antitumor therapy (except in the case of immunotherapy) was attempted due to the high tumor burden and poor ECOG PS score in this patient. After effective communication with the family members, toripalimab was attempted in this patient with great success (the patient did not receive chemotherapy and only received immunotherapy). In the spring of 2019, imported programmed death receptor-1 (PD-1) antibodies (pabolizumab and navulizumab) listed in the Chinese market were expensive, and the people could not afford the cost. However, treprizumab was just on the market, with low price and high pharmacoeconomics. Therefore, the drug was selected for treatment.) The patient achieved almost complete remission, with a progression-free survival (PFS) of about 2.5 years. The expression of programmed death-ligand 1 (PD-L1) was high in this patient. Toripalimab monotherapy may be applied in patients with high PD-L1 expression although any potential adverse effects should be closely monitored. To our knowledge, no other data from clinical trials and real-world cases have thus far been reported concerning the application of immunotherapy in ECOG PS 4 patients with advanced lung cancer. The innovation of this article is that although the patient has advanced cancer and ECOG PS 4 is an end-stage patient, immunotherapy is still given and achieved great success.