Late-stage esophageal neuroendocrine carcinoma in a patient treated with tislelizumab combined with anlotinib: a case report

Abstract

Esophageal neuroendocrine carcinoma (ENEC) is an extremely rare tumor with highly malignant potential, rapid growth, and a poor prognosis. Advanced extrapulmonary neuroendocrine carcinoma should be treated with chemotherapeutic regimens suitable for small cell lung cancer. However, ENEC has no clear second-line treatment options. The clinical application of immunotherapy and targeted therapy in small cell lung cancer has produced good therapeutic effects. We describe the case of an elderly woman with multiple metastatic advanced ENEC treated with tislelizumab combined with anlotinib as second-line therapy, achieving complete remission in a short period and long-term survival. In total, 21 cycles of tislelizumab combined with anlotinib were given to this patient. After two cycles, the patient's neuron-specific enolase level decreased from 181.8 to 22.9 µg/L and remained at normal levels throughout treatment. Progression-free survival and overall survival were 16 and 21 months, respectively, in this patient. No obvious side effects were observed. Thus, tislelizumab and anlotinib could represent a novel therapeutic option for advanced ENEC.

Keywords: Tislelizumab; anlotinib; case report; chemotherapy; esophageal neuroendocrine carcinoma; immunotherapy; small cell lung cancer; targeted therapy.

Figure 1.

Results of initial endoscopy for the patient. (a, b) Digestive endoscopy revealed a space-occupying lesion in the esophagus, and the lumen was obviously narrowed and (c) Digestive endoscopy revealed a tumor-occupying site in the gastric fundus.

Figure 2.

Results of CT before and after chemotherapy. (a1) Enhanced CT revealed the enlargement of multiple right supraclavicular lymph nodes. (a2) CT illustrated that the esophageal wall of the esophagus was significantly thickened with unequal enhancement. (a3) CT revealed multiple enlarged lymph nodes on the lesser curvature side of the stomach that fused into a mass. (a4) CT revealed multiple lymphadenopathy in the abdominal cavity and retroperitoneum. (b1–4) CT of the chest and whole abdomen revealed that the thickness of the esophageal wall was significantly reduced compared with the previous examination, multiple lymph nodes in the mediastinum, neck, abdominal cavity, and retroperitoneum were enlarged, and the tumor volume was significantly lower than that in the prior examination. CT, computed tomography.

Figure 3.

The results of CT in the patient before and after immunotherapy combined with targeted therapy. (a1–b1) Enhanced CT of the chest and whole abdomen revealed that the lymph nodes in the abdominal cavity and retroperitoneum had increased in number and size. (a2–b2) After two cycles of tislelizumab plus anlotinib, the lymph nodes in the liver and stomach space had shrank, and the lymph nodes next to the middle abdominal artery were enlarged but weakened. (a3–b3) After four cycles of treatment, some of the metastases had completely disappeared, and the other metastases had shrank and (a4–b4) After eight cycles of treatment, repeated CT revealed that the lymph nodes in the abdominal cavity and retroperitoneum had shrank. CT, computed tomography.

Figure 4.

NSE levels in the patient over the course of tislelizumab plus anlotinib therapy. NSE, neuron-specific enolase.