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Case Reports
. 2021 May 29;57(6):547.
doi: 10.3390/medicina57060547.

Bevacizumab-Containing Chemoimmunotherapy for Recurrent Non-Small-Cell Lung Cancer after Chemoradiotherapy: Case Report

Nobutaka Kataoka  1 , Yusuke Kunimatsu  1 , Rei Tsutsumi  1 , Nozomi Tani  1 , Izumi Sato  1 , Mai Tanimura  1 , Takayuki Nakano  1 , Keiko Tanimura  1 , Daishiro Kato  2 , Takayuki Takeda  1
Affiliations
Case Reports

Bevacizumab-Containing Chemoimmunotherapy for Recurrent Non-Small-Cell Lung Cancer after Chemoradiotherapy: Case Report

Nobutaka Kataoka et al. Medicina (Kaunas). .

Abstract

Chemoimmunotherapy has become the standard of care as the first-line treatment of advanced or recurrent non-small-cell lung cancer (NSCLC). The bevacizumab-containing chemoimmunotherapy regimen is theoretically more effective than a non-bevacizumab-containing regimen via two mechanisms: a superior outcome of bevacizumab-containing chemothrerapy than the standard platinum doublet regimen, and the synergistic effect of bevacizumab with an immune checkpoint inhibitor (ICI). Bevacizumab effectively normalizes vascularization, especially when the vascular bed is damaged by previous treatment. Bevacizumab promotes immunomodulation when used with ICI. We describe a patient with nonsquamous NSCLC who returned 2.5 years after definitive chemoradiotherapy for postoperative locoregional recurrence in the right supraclavicular lymph node. Considering the destroyed vascular bed due to prior chemoradiotherapy, attaining vascular normalization was critical for effective drug delivery. The patient was treated with a bevacizumab-containing chemoimmunotherapy regimen, which resulted in a complete metabolic response. The patient responded well for 23 months and is receiving ongoing treatment. Thus, bevacizumab-containing chemoimmunotherapy could be advantageous in some recurrent cases after chemoradiotherapy.

Keywords: bevacizumab; chemoimmunotherapy; chemoradiotherapy; non-small-cell lung cancer; recurrence.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) obtained 2.5 years after definitive chemoradiotherapy (A) demonstrated a right supraclavicular lymph node swelling with a maximum standardized uptake value of FDG scoring 3.3. Contrast-enhanced CT (B) showed a right supraclavicular lymph node swelling of 7.4 mm in shorter diameter.
Figure 2
Figure 2
Contrast-enhanced CT after two cycles of induction therapy (A) with atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) demonstrated partial response (PR), and 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT after four cycles of induction therapy (B) showed metabolically PR with a maximum standardized uptake value of FDG decreasing to 1.5. FDG/PET after 11 cycles of continuation maintenance therapy (C) with atezolizumab and bevacizumab exhibited complete metabolic response without any FDG accumulation.
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