Pathologic complete response after neoadjuvant tislelizumab and chemotherapy for Pancoast tumor: A case report

Abstract

A 60-year-old man was hospitalized because of numbness and weakness in the right upper limb. Magnetic resonance imaging revealed a large mass in the right upper lobe invading the right eighth cervical and first thoracic nerve root. Biopsy pathology confirmed primary lung adenocarcinoma with a clinical stage of cT4N0M0 IIIA, negative for anaplastic lymphoma kinase fusion gene and epidermal growth factor receptor mutations but positive for programmed death ligand 1 (3%). Neoadjuvant tislelizumab and chemotherapy were offered to this patient with Pancoast tumor, and tumor shrinkage of 71% was achieved. After the operation, surgical pathology indicated pathologic complete response (pCR). Circulating tumor cells testing was negative after the first adjuvant treatment. In this case, we provide real-world evidence of encouraging pCR with neoadjuvant tislelizumab and chemotherapy for a patient with Pancoast tumor.

Keywords: Pancoast tumor; immunotherapy; neoadjuvant; pCR.

FIGURE 1

The process of treatment in this case, including dynamic radiological and pathological evaluation, NGS and PD‐L1 testing, related tumor indicators, and circulating tumor cells testing. ALK, anaplastic lymphoma kinase; CEA, carcino‐embryonic antigen; chemo, chemotherapy; CTC, circulating tumor cells; CYFRA21‐1, cytokeratin fragment antigen 21–1; EGFR, epidermal growth factor receptor; ICI, immune checkpoint inhibitors; LUAD, lung adenocarcinoma; LND, lymph node dissection; NGS, next‐generation sequencing; NSE, neuron‐specific enolase; pCR, pathologic complete response; PD‐L1, programmed death ligand 1; RECIST, response evaluation criteria in solid tumors

FIGURE 2

Integrated assessment for pathological diagnosis before and after neoadjuvant treatment including CK7, NapsinA, P63, P40, TTF‐1, CgA, Syn, CK. HE, hematoxylin, and eosin