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Case Report
Pembrolizumab leading to complete resolution of non-small cell lung cancer and microsatellite instability stable colon adenocarcinoma; two birds one stone
1 Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
2 Department of Internal Medicine, University of Washington, Seattle, WA 98195, USA
3 Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA
4 Division of Oncology, University of Texas Medical Branch, Galveston, TX 77555, USA
5 Department of General Oncology, MD Anderson, Houston, TX 77030, USA
6 Department of Allergy and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA
Address correspondence to:
Pooja Bhakta
University of Texas Medical Branch, 300 Harborside Drive, Galveston, TX 77555,
USA
Message to Corresponding Author
Article ID: 100111Z10PB2022
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How to cite this article
Bhakta P, Salazar L, Youssef A, Kendrick JC, Patel N, Willis M, Muthukumarana P, He J, Tripple J. Pembrolizumab leading to complete resolution of nonsmall cell lung cancer and microsatellite instability stable colon adenocarcinoma; two birds one stone. J Case Rep Images Oncology 2022;8(2):20–27.ABSTRACT
Introduction: Staging of non-small cell lung cancer is crucial in predicting patient prognosis and more importantly, determining cancer management. In patients without driver mutations, PD-L1 tumor proportion score evaluation becomes vital in dictating treatment, as immunotherapy can be recommended. These agents have been shown to lead to excellent outcomes, even in patients with late-stage disease.
Case Report: A 69-year-old male with a history of chronic obstructive pulmonary disease (COPD) presented with worsening dyspnea found to have lung collapse from a large hilar soft tissue mass causing obstruction of the left mainstem bronchus. After malignancy workup, the patient was diagnosed with non-small cell lung cancer clinically staged as IIIB. An incidental finding of microsatellite instability colon cancer was also found during workup. Pembrolizumab treatment was initiated and led to near resolution of both tumors.
Conclusion: Stage IIIB non-small cell lung cancer has an overall poor prognosis. Biomarker testing in our case prior to starting concurrent chemoradiation revealed the malignancy to have a 100% tumor proportion score for PD-L1, the fundamental reason why our patient’s treatment was successful. Based on our findings, we advocate for all patients with non-small cell lung cancer regardless of stage to undergo biomarker testing prior to therapy initiation. Furthermore, the resolution of PD-L1 negative microsatellite instability stable colon cancer after pembrolizumab therapy supports further investigation of the utility and mechanism of PD-1/PD-L1-based therapy in PD-L1 negative colon cancer.
Keywords: Colorectal cancer, Genotyping, Microsatellite instability, Non-small cell lung cancer, Pembrolizumab
SUPPORTING INFORMATION
Author Contributions
Pooja Bhakta - Substantial contributions to conception and design, Acquisition of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Leonardo Salazar - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ayman Youssef - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jamie C Kendrick - Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Nekita Patel - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Maurice Willis - Revising it critically for important intellectual content, Final approval of the version to be published
Palawinnage Muthukumarana - Revising it critically for important intellectual content, Final approval of the version to be published
Jing He - Revising it critically for important intellectual content, Final approval of the version to be published
Julia W Tripple - Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Pooja Bhakta et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
