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Case Reports
. 2019 Mar 4;14(1):50.
doi: 10.1186/s13019-019-0862-6.

Endoscopic central airway recanalization to enable first line pembrolizumab treatment in a PD-L1 strongly positive non-small cell lung cancer: a case report

Alfonso Fiorelli  1   2 , Fabio Perrotta  3 , Mariano Mollica  4 , Mario Santini  5 , Fabiana Vitiello  6 , Marina Gilli  6 , Cecilia Calabrese  4 , Andrea Bianco  4
Affiliations
Case Reports

Endoscopic central airway recanalization to enable first line pembrolizumab treatment in a PD-L1 strongly positive non-small cell lung cancer: a case report

Alfonso Fiorelli et al. J Cardiothorac Surg. .

Abstract

Background: Tracheobronchial malignant stenosis is a life-threatening condition which may cause recurrent infections due to lung atelectasis. Despite immunotherapy is less toxic than standard chemotherapy, recurrent lung infections may represent a challenge for this treatment. We report a clinical case of a patient with metastatic squamous cell carcinoma suffering from pulmonary infections due to central airway obstruction who underwent endoscopic recanalization followed by immunotherapy.

Case presentation: A 64 year-old man was referred to our attention for the management of metastatic squamous cell carcinoma obstructing the right main bronchus with recurrent pulmonary infections. Patient exhibited strong positive PD-L1 expression (> 50%). Advanced disease stage contraindicated surgical treatment. Although therapy with immune check point inhibitors was indicated as first-line treatment, recurrent pulmonary infections made it unfeasible. Therefore, we planned a combined approach including endoscopic recanalization of central airway in order to resolve lung atelectasis, and lung infection followed by immunotherapy treatment with pembrolizumab in order to avoid local and systemic disease progression.

Conclusions: At 16-week follow-up, the patient was alive in stable disease with improvement of clinical condition and no signs of lung infection.

Keywords: Endoscopic airway recanalization; Immunotherapy; NSCLC; PD-L1; Pembrolizumab.

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Conflict of interest statement

Ethics approval and consent to participate

Patient signed an informed consent for the operation and was aware that his data could be used for scientific purpose.

Consent for publication

Patient was aware that his data could be used for scientific purpose.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Chest x-rays showed pulmonary atelectasis involvement due to the cancer progression associated with four recurrent episodes of lung infection
Fig. 2
Fig. 2
Chest computed tomography scan at the admission, showed the obstruction of the right main bronchus (black arrow) (a), the atelectasis of the middle lobe and the pneumonia of lower lobe (white arrow) with pleural effusion (b). The endoscopic recanalization with stent placement allowed to obtain the resolution of atelectasis and lung infection (c)
Fig. 3
Fig. 3
The picture edited the main steps of endoscopic recanalization. Complete obstruction of the right main bronchus from the level of the carina by an extrinsic tumor (a); complete recanalization of the right main bronchus, middle and lower lobe bronchus (b); insertion of the stent with a dedicated delivery catheter to cover the right upper lobe where the tumor originated (c); patency of right main bronchus after stent insertion (d)
Fig. 4
Fig. 4
Chest CT scan performed before (Part a), and 16 weeks after immunotherapy (Part b) showed a reduction in tumor size (white arrow) without sign of lung infection
See this image and copyright information in PMC

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