Long-Term Response of Pembrolizumab in a Patient with Metastatic Squamous Non-Small Cell Lung Cancer on Hemodialysis: Case Report and Review of the Literature

Abstract

In patients with renal failure and hemodialysis, there are difficulties in drug selection and dose adjustment for cancer treatment. The use of immune checkpoint inhibitors (ICIs), including pembrolizumab, approved by the U.S. Food and Drug Administration (FDA) for patients with metastatic non-small cell lung cancer (NSCLC) in 2015, has become an important option for the treatment of metastatic NSCLC. However, data regarding the dosage and schedule for long-term use of ICIs, especially pembrolizumab, in hemodialysis patients are limited. We present the case of a patient with metastatic squamous NSCLC who demonstrated a long-term partial response to pembrolizumab monotherapy for 45 months during hemodialysis and showed no immune-related adverse events (irAEs). To our knowledge, this is the longest remission to be reported without irAEs after discontinuation of pembrolizumab in a NSCLC patient undergoing HD. In addition, we reviewed previously reported lung cancer patients who used ICI during dialysis, comparing them with our case in clinical aspect. We believe that this report will provide clinical insights into the long-term efficacy and safety of pembrolizumab in lung cancer patients undergoing hemodialysis.

Keywords: chronic kidney disease; end-stage renal disease; hemodialysis; non-small cell lung cancer; pembrolizumab.

Figure 1

[F-18]FDG PET/CT scan and serial CT scans of the chest before and after pembrolizumab administration. (A) The [F-18]PET/CT scan on 16 February 2016 showed [F-18]FDG uptake in metastatic nodules in left upper lobe and left lower lobe. (B–F) The CT scans serially showed decreased extent of metastases in left lower lobe and left lower lobe from 26 March 2018 to 29 December 2021.

Figure 2

CT scan of the chest and [F-18]PET/CT scan on progression. (A,B) The CT scan of the chest on 22 March 2022 showed increased size of an increasing mass in central area of left upper lobe and enlarged LNs, as well as several new small nodules in both lungs. (C,D) The [F-18]PET/CT scan on 6 April 2022 showed [F-18]FDG uptake in metastatic nodules in the left and right upper lobes.