Spontaneous Remission Of Advanced Progressive Poorly Differentiated Non-small Cell Lung Cancer: A Case Report And Review Of Literature
Yoon, H. Y., Park, H. S., Cho, M. S., Shim, S. S., Kim, Y., & Lee, J. H. (2019). Spontaneous remission of advanced progressive poorly differentiated non-small cell lung cancer: a case report and review of literature. BMC pulmonary medicine, 19(1), 210. https://doi.org/10.1186/s12890-019-0978-4
View Original Source →Abstract
BACKGROUND: Spontaneous remission (SR) of cancer is a very rare phenomenon of unknown mechanism. In particular, SR of non-small cell lung cancer (NSCLC) has been scarcely reported. We present the case of a 74-year-old woman with advanced, poorly differentiated NSCLC (highly expressing programmed death ligand-1 [PD-L1]) that progressed despite multiple lines of chemotherapy but then spontaneously remitted. CASE PRESENTATION: The patient presented with hemoptysis and was diagnosed with stage IIIA poorly differentiated NSCLC via bronchoscopic biopsy. She had an unremarkable medical history and moderate performance status. The initial treatment plan was surgery after neoadjuvant chemotherapy. Despite conventional chemotherapy, follow-up chest computed tomography (CT) showed gradual tumor progression and she decided against further treatment after fifth-line chemotherapy. However, the size of lung mass was markedly decreased on follow-up chest CT one year after ceasing chemotherapy. Also, follow-up positron emission tomography images showed decreased metabolic activity in the lung mass and a percutaneous biopsy specimen from the diminished lung mass revealed no viable tumor cells. A diagnosis of SR of NSCLC was confirmed, and the patient was without tumor progression on follow-up nine months later. Later, PD-L1 immunostaining revealed high positivity (> 99%) in initial tumor cells. CONCLUSION: Our case showing SR of poorly advanced NSCLC refractory to multiple lines of chemotherapy suggested the association between immunity and tumor regression.
Case Details
Disease Location
Lung
Personal Characteristics
74-year-old woman
Clinical Characteristics
With a history of a lung mass on a chest x-ray performed for evaluation of recurrent hemoptysis. Physical examination revealed decreased lung sounds in the left lower lung field. Chest x-ray and computed tomography (CT) scan revealed a 5.1 × 2.9 cm lung mass in the left upper lobe with a surrounding halo of ground-glass attenuation. There were also tiny lung nodules in the right upper and lower lobes that could not be ruled out for malignancy, and left hilar lymph node enlargement. Diagnostic bronchoscopy revealed a polypoid mass with luminal obstruction of the left lingular inferior segmental bronchus. Histologic examination of an initial bronchoscopic biopsy showed poorly differentiated carcinoma with many tumor-infiltrating lymphocytes. The patient planned to undergo surgery after two cycles of paclitaxel plus carboplatin as neoadjuvant chemotherapy, inducing a decrease in the size of the lung mass from 5.1 × 2.9 cm to 4.1 × 1.5 cm. However, the patient developed drug-induced hepatitis due to a self-prescribed herbal medication, and the surgery schedule was delayed. She received an additional two cycles of paclitaxel plus carboplatin. The patient received second-line for 4 cycles of gemcitabine plus carboplatin, third-line for 2 cycles of pemetrexed, fourth-line for 4 cycles of weekly docetaxel, and fifth-line for 1 cycle of weekly vinorelbine. She refused further chemotherapy. 4 months after discontinuation of chemotherapy, the size of the tumor, directly invading the left main pulmonary artery, left atrium, and left lower lobe. Thus, the patient again started irinotecan plus carboplatin as sixth-line chemotherapy, which was later discontinued.
Remission Characteristics
One year after discontinuation of treatment, a chest x-ray showed that the lung mass had decreased in size. The patient had been taking herbal medication (orostachys japonicus extracts) over the preceding few months. Repeat tumor biopsy, only found fibrotic scar blocking the ligular segment instead of an endobronchial mass. Percutaneous needle biopsy of the left lung lesion showed marked deposition of collagen and elastic fibers without tumor cells.
Treatment & Mechanisms
Proposed Remission Mechanisms
Immune mediated response
Clinical Treatment
Biopsy, chemotherapy
Non-Clinical Treatment
Orostachys japonicus extracts