OncoTargets and Therapy (Aug 2020)
Immune Checkpoint Inhibitor Therapy Achieved Complete Response for Drug-Sensitive EGFR/ALK Mutation-Negative Metastatic Pulmonary Large-Cell Neuroendocrine Carcinoma with High Tumor Mutation Burden: A Case Report
Abstract
Xin Zhang,1 Yanbin Sun,1 Yuan Miao,2 Shun Xu1 1The Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, People’s Republic of China; 2The Department of Pathology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, People’s Republic of ChinaCorrespondence: Shun XuThe Department of Thoracic Surgery, The First Hospital of China Medical University, 155# Nanjing North Street, Shenyang 110001, People’s Republic of ChinaTel +86 02483283170Email [email protected]: Large-cell neuroendocrine lung carcinoma (LCNELC) is classified into lung neuroendocrine tumors according to WHO 2015 classification guidelines and represents approximately 3% of all lung cancer. Because of the rarity of LCNELC, there is a lack of prospective studies guiding treatment. Here, we report a case of a patient with pT2aN2M0 stage IIIA LCNELC (drug-sensitive EGFR/ALK mutation-negative, PD-L1-negative but tumor mutation burden (TMB) high), who progressed rapidly after surgery but achieved a complete response to subsequent immune checkpoint inhibitor (ICI) therapy. The concentration of circulating tumor DNA (ctDNA) following the treatment course strongly reflects the response to ICI therapy. This report highlights the efficacy of ICI treatment in metastatic LCNELC patients with a high TMB and suggests that ctDNA analysis in detecting molecular residual disease may facilitate the personalization of ICI therapy.Keywords: metastatic large-cell neuroendocrine lung carcinoma, adrenal gland metastasis, next generation sequencing, immune checkpoint inhibitor, circular tumor DNA
