The use of atezolizumab in combination with chemotherapy in first-line of metastatic small cell lung cancer. Case report

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Abstract

Background. Lung cancer (LC) occupies a leading position among malignant tumors in the world, it accounts for 11.4% of the total malignant neoplasms. In 2020, there were 2 206 771 new cases of LC and 1 796 144 deaths worldwide. Among the histological variants, small cell LC (SCLC) has the most unfavorable outcomes. This variant is considered highly sensitive to chemotherapy. Despite some successes in the treatment of this disease, the results of treatment remain problematical. In recent years, the use of immune checkpoint inhibitors has provided significant control of the course of the disease.

Aim. To show the efficacy of atezolizumab in combination with chemotherapy in patients with metastatic SCLC.

Materials and methods. A 76-year-old patient with left lung cancer, IVA T4N3M1b, the right supraclavicular lymph node metastases, exudative pleuritis of the left lung was under observation. The histological investigation showed SCLC. Brain metastases were not detected. ECOG 0.

Results. The patient was treated using atezolizumab 1200 mg in combination with carboplatin 5 AUC and etoposide 100 mg/m2 on days 1, 2, 3 for four cycles, followed by a maintenance therapy regimen with atezolizumab 1200 mg every 21 days. The patient received 21 injections during 14 months. The assessment of treatment effect was evaluated using combined 18F-fluorodeoxyglucose positron emission and X-ray computed tomography. As a result of the treatment, after 7 months, a complete clinical and morpho-metabolic regression of the tumor was reached, which persisted throughout the period of the treatment. Among the adverse events were detected grade 2 anemia and first-stage sensory neuropathy. No immune-related adverse events were observed.

Conclusion. The addition of atezolizumab to etoposide + carboplatin as the first-line therapy for extensive-stage SCLC provides the long-term overall and disease-free survival with achieving the satisfactory quality of life in patients and acceptable drug tolerance.

About the authors

Nikolai A. Ognerubov

Derzhavin Tambov State University; Tambov Regional Oncological Clinical Dispensary

Author for correspondence.
Email: ognerubov_n.a@mail.ru
ORCID iD: 0000-0003-4045-1247
SPIN-code: 3576-3592

D. Sci. (Med.), Cand. Sci. (Law), Prof.

Russian Federation, Tambov; Tambov

Tatyana S. Antipova

“PET-Technoligy” Ltd; Nuclear Medicine Center

Email: antipovats@gmail.com
ORCID iD: 0000-0003-4165-8397

doctor

Tambov; Tambov

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2. Fig. 1. A 76-year-old patient P. before the treatment. MIP and axial PET/CT images show an enlarged metabolically active right supraclavicular lymph node measuring 14×9 mm, SUVmax 7.82. Against the background of atelectasis of the left lower lobe, a tumor mass formation (yellow arrow) is visualized in S10, extending to the root of the lung, with a total size measuring 41×57×81 mm, adjacent to the posterior costal and paraspinal pleura, with increased FDG metabolic activity (SUVmax 10.75). Enlarged paratracheal, bifurcation, bronchopulmonary lymph nodes (SUVmax 11.20) and aortopulmonary window lymph nodes measuring 21×45 mm, SUVmax 10.53 (red arrow) is detected.

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3. Fig. 2. A 76-year-old patient P. after 6 injections of atezolizumab (3 months after the start of treatment). MIP and axial PET/CT images show the regression of the right supraclavicular lymph node. Right lung ventilation is restored. In S10 the pneumofibrosis at the site of atelectasis with a nodular formation in a structure measuring 15×16×15 mm (previously measuring 41×57×81 mm) with the clear margins without FDG metabolic activity (yellow arrow) is detected. There is no exudate in the pleural and pericardial cavities. The size of paratracheal, bifurcation and aortopulmonary window lymph nodes decreased and without uptake of the RFP (red arrow).

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4. Fig. 3. A 76-year-old patient P. after 10 injections of atezolizumab (6 months after the start of treatment). MIP and axial PET/CT images did not show the right supraclavicular lymph. In the lower lobe of the left lung at the site of the pathological lesion, a band of fibrous tissue with a nodular formation (yellow arrow) is determined in a structure measuring 13×14 mm (previously 15×16 mm) without FDG metabolic activity. There is a regression of the paratracheal lymph nodes from the upper level to the bifurcation. Aortopulmonary window lymph nodes are measuring 10×12 mm (red arrow).

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5. Fig. 4. A 76-year-old patient P. after 16 injections of atezolizumab (10 months after the beginning of treatment). A band of fibrous tissue with a nodular formation in a structure measuring 12×10 mm without FDG metabolic activity in the lower lobe of the left lung is still detected on MIP- and axial PET/CT images. Aortopulmonary window lymph nodes measuring 10 mm with focal RFP uptake are still detected.

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6. Fig. 5. A 76-year-old patient P. after 20 injections of atezolizumab (after 13 months from the beginning of treatment). A band of fibrous tissue with a nodular formation in a structure of the same configuration measuring 12×10 mm without FDG metabolic activity and aortopulmonary window lymph nodes with focal RFP uptake in the lower lobe of the left lung are still detected on MIP- and axial PET/CT images.

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