Lung Womo is cloud courier: Navuliyu single anti-treatment first-line progress of lung scale cancer with brain metastasis patients PFS for more than 3.5 years.

Lung cancer is the first cancer in China.lung squamous cell carcinoma is the most common type of lung cancer, accounting for 40% - 51% of primary lung cancer.in 2018, the Chinese non-small cell lung cancer (NSCLC) entered the era of immunotherapy.the addition of these PD-1 inhibitors opens a door for the treatment of patients with lung squamous cell carcinoma.yimaitong had the honor to invite Professor Wang Li of Jiangsu cancer hospital to share a classic case of PFS more than 3.5 years after treatment with navulizumab in patients with lung squamous cell carcinoma and brain metastasis, and invited Professor Shi Meiqi of Jiangsu cancer hospital to give a wonderful comment on this case.share below.the basic history of some cases: Zheng x, male, 63 years old.in October 2015, due to "cough and expectoration for more than one month", chest CT showed "right lower lung space occupying", and lung space occupying tissue biopsy showed "moderately differentiated squamous cell carcinoma in the right lung". Therefore, from November 6, 2015 to November 29, 2015, two cycles of "paclitaxel + carboplatin" chemotherapy were performed in an external hospital, and the specific dosage was unknown.for further diagnosis and treatment, we came to our hospital.they were healthy in the past, denied the history of chronic diseases, infectious diseases and other diseases, and denied the history of allergy.denied smoking history and family genetic history.ECoG: 1 point.auxiliary examination: puncture biopsy: lung space occupying biopsy pathology (November 6, 2015): (right lung) squamous cell carcinoma (moderately differentiated).PD-L1 was not detected.imaging examination: ① chest CT (2015-10): space occupying right lower lung, considering the possibility of right central lung cancer with peripheral obstructive pneumonia and mediastinal lymph node enlargement; ② head enhanced MRI (2015-10): no obvious abnormality.diagnosis: right lower lung squamous cell carcinoma (t2n3m0, stage IIIB), mediastinal lymph node metastasis.treatment history: first line treatment: the patient received paclitaxel + carboplatin chemotherapy for 2 cycles in the hospital on November 6, 2015 and November 29, 2015, and the specific dosage is unknown. on December 29, 2015, we went to the Department of radiotherapy of our hospital for localization under CT, and then received two cycles of "paclitaxel + carboplatin" chemotherapy on December 31, 2015 and February 14, 2016. After the third cycle of chemotherapy (2016-01-07), sequential radiotherapy was performed for right lung lesions and mediastinum, with a total dose of dt60gy / 20f. on February 2, 2016, the chest and abdomen CT reexamined after radiotherapy showed that "the mass near the right pulmonary hilum is smaller than the former, and the solid component is smaller than the former; the multiple lymphadenopathy of the right hilar and mediastinum is smaller than the former", and the curative effect evaluation: SD. Figure 1: chest CT of the patient after 2 cycles of chemotherapy on December 29, 2015; 2. Chest CT reexamined after radiotherapy on February 2, 2016; February 14, 2016; after the fourth cycle of chemotherapy, the patient entered the stage of close observation and follow-up, and did not receive any anti-tumor treatment. on August 11, 2016, 6 months after the end of chemotherapy, the head + chest and abdomen CT showed that "the right parahilar lesions did not change much; the right lung radiation inflammation; the mediastinum and hilar lymph nodes did not change much; left cerebellar lesions, considering metastasis", the curative effect evaluation: PD, considering the disease progression. Fig. 3 chest CT image of the patient 6 months after the end of chemotherapy on August 11, 2016 4 Second line CT treatment of the head reviewed 6 months after the end of chemotherapy on August 11, 2016: on August 16, 2016, the patient participated in ca209-078 "open, randomized, Multi Country phase III trial of navulizumab versus docetaxel in the treatment of previously treated advanced or metastatic non-small cell lung cancer". on August 17, 2016, before treatment, cranial MRI showed that "mass can be seen in the left cerebellum, the maximum cross-sectional size of the lesion is about 3.99 × 2.98cm. Considering the metastasis, there is no enhanced edema area around the lesion, and the fourth ventricle and left annular cistern are slightly compressed and deformed". Figure 5 the MRI (baseline) of the patient's brain was reviewed before treatment on August 17, 2016. The patients were randomly divided into the treatment group and received the immunotherapy of navulizumab from August 29, 2016, with the specific dose of 3 mg / kg of navulizumab q2w. on October 8, 2016, after 3 cycles of treatment, chest and abdomen CT showed that "the right lung lesions were smaller than before, and the peripheral radioactive inflammatory changes were improved; the multiple lymph nodes in mediastinum and right hilar were slightly smaller than those in the front; bilateral pleura was slightly thickened, slightly more obvious than before"; brain MRI showed that "left cerebellar mass, the largest cross-sectional size of the lesion was about 2.82 × 1.55cm, and the metastatic focus was considered There was no enhancement and edema around the lesion, but absorption was improved. The fourth ventricle and left annular cistern were slightly compressed and deformed. "was evaluated as pr. Fig. 6 the chest CT reexamined after 3 cycles of treatment with navulizumab on October 8, 2016 was followed by 3 cycles of treatment with navulizumab, and PR was still judged after 6 cycles. Figure 7: the patients were reexamined on August 17, 2016 (baseline), 2016-10-08 (3 cycles), and 2017-01-09 (6 cycles), with continuous immunotherapy and regular review. after 3 years of immunotherapy with navulizumab (80 cycles in total), the patient's condition was significantly improved and maintained PR status (chest lesions were stable; brain metastases continued PR, no new lesions). Fig. 8 the brain MRI changes of the patients reviewed during the treatment of navulizumab on May 15, 2017, August 17, 2018, January 28, 2019 and April 17, 2019 were reviewed. As the patient was a provincial patient, considering the long way to hospital, he withdrew from the clinical trial and terminated the immunotherapy on November 21, 2019. the patients had herpes zoster and elevated serum amylase (all grade 1) during immunotherapy, and no serious adverse events occurred. Fig. 9 chest CT of the patient after 80 cycles of treatment with navulizumab on October 15, 2019, and brain MRI of the last review of the patient after 80 cycles of treatment with navulizumab on October 6, 2020. After stopping immunotherapy for more than 3 months, telephone follow-up showed that the patient had no special discomfort and did not undergo any examination and treatment during the period. case summary: the patient was diagnosed as right lower lung squamous cell carcinoma (t2n3m0, stage IIIB) and mediastinal lymph node metastasis in October 2015. "the first-line treatment was treated with paclitaxel + carboplatin for 4 cycles, and local radiotherapy was performed after the third cycle. The PFS was 9 months, and the best judgment effect was SD; because of brain metastasis, the second-line treatment was changed to navulizumab for immunotherapy, PFS & gt; 3.5 years, the best judgment effect was pr. no serious adverse events occurred during the treatment; after that, immunotherapy was stopped for personal reasons, OS & gt; 51 months (4.25 years). case review case introduction expert comments 1. Lung cancer patients with brain metastases have short survival time and poor prognosis, and the treatment options are limited. During the course of treatment with navulizumab, the brain metastases were significantly reduced, and the duration of remission was more than 3.5 years. 3. PD-1 inhibitors can penetrate the blood-brain barrier, so that lung cancer patients with brain metastasis can also obtain good curative effect. 4. PD-1 inhibitors have a long tailing effect, and once effective, they are usually persistent. The patient was well tolerated during immunotherapy, and no serious adverse events occurred during the treatment. conclusion: as the first immune checkpoint inhibitor on the market in China, it has been approved for second-line treatment of patients with non-small cell lung cancer (NSCLC). at present, PD-1 inhibitors are playing an increasingly important role in advanced lung cancer. after first-line chemotherapy and sequential radiotherapy, the patient's condition progressed and brain metastases occurred. In the second-line treatment, the patient was treated with navulizumab. PFS was more than 3.5 years, and OS was more than 51 months (4.25 years). No serious adverse events occurred during the treatment. The patient benefited significantly from immunotherapy. patients with brain metastases from lung cancer usually have poor prognosis and short survival time. Many clinical trials often regard it as the exclusion criteria and do not study them. Therefore, for patients with brain metastasis of lung cancer, the clinical options are very limited. after the use of single drug therapy, the brain metastases of this patient were significantly smaller than before, reaching PR status, and the duration of remission was more than 3.5 years. It is suggested that PD-1 inhibition system can penetrate the blood-brain barrier and make lung cancer patients with brain metastasis achieve clinical benefits. Moreover, immunotherapy has a long tail effect. Once the effect takes effect, the effect is usually longer. OPD-SL-1030-200713-210713