Spontaneous Regression Of An Epidermal Growth Factor Receptor-mutant Left Upper Lobe Adenocarcinoma
Schiavon, M., Lloret Madrid, A., Pezzuto, F., Giraudo, C., Comacchio, G. M., Faccioli, E., Dell'Amore, A., Calabrese, F., & Rea, F. (2022). Spontaneous Regression of an Epidermal Growth Factor Receptor-mutant Left Upper Lobe Adenocarcinoma. The Annals of thoracic surgery, 114(4), e261–e264. https://doi.org/10.1016/j.athoracsur.2021.11.064
View Original Source →Abstract
Spontaneous regression of cancer is a known manifestation rarely described for thoracic malignancies. We present the case of a patient affected by an epidermal growth factor receptor-mutant adenocarcinoma who developed a contralateral aspiration pneumonitis months before surgery and manifested a complete pathologic regression without any preoperative oncologic treatment. The underlying mechanisms are not clear, but immune system activation appears to be a key player, acting as a plausible trigger of a change in host response to cancer cells. The tumor microenvironment does not appear to be an "inert spectator" but rather an "active protagonist" on the course of the disease and its therapeutic targeting.
Case Details
Disease Location
Lung
Personal Characteristics
74-year-old man. History of 40 pack-years, atrial fibrillation, diabetes mellitus, and chronic kidney disease.
Clinical Characteristics
Chest CT showed a left upper lobe mass. A bronchoscopy with transbronchial lung biopsy yielded a diagnosis of adenocarcinoma. Molecular analysis detected an l858r exon 21 egfr mutation. A new total body CT revealed a pulmonary consolidation in the middle lobe with inhomogeneous contrast enhancement suggesting early areas of necrosis because of aspiration pneumonitis given the known clinical history of dysphagia. The patient was treated with ciprofloxacin, azithromycin, and prednisone for 2 weeks. One month later, the patient underwent video-assisted left upper lobectomy with systematic mediastinal lymph node dissection
Remission Characteristics
Pathologic examination showed no residual areas of lung adenocarcinoma even after several samples. The lung parenchyma showed multiple abscess foci and bronchiectasis with extensive inflammatory infiltration, sometimes aggregated in a follicular pattern
Treatment & Mechanisms
Proposed Remission Mechanisms
Infection/biopsy-related enhanced by ciprofloxacin and egfr mutation
Clinical Treatment
Biopsy, ciprofloxacin, azithromycin, and prednisone