2023 World Conference on Lung Cancer (Posters)-EP11.03. Successful Treatment with Pembrolizumab Alone for SMARCA4-deficient Lung Sarcomatoid with a High-TMB and PD-L1(+) A Case Report

EP11.03. Successful Treatment with Pembrolizumab Alone for SMARCA4-deficient Lung Sarcomatoid with a High-TMB and PD-L1(+) A Case Report - PDF(Abstract)

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This case report discusses the successful treatment of a patient with SMARCA4-deficient lung sarcomatoid using pembrolizumab, an immune checkpoint inhibitor. SMARCA4 is a subunit of the SWI/SNF chromatin-remodeling complex, and SMARCA4-deficient non-small cell lung cancer (NSCLC) can be divided into carcinoma and sarcomatoid types. While there have been suggestions of a correlation between immune checkpoint inhibitors and the SWI/SNF complex, little is known about their efficacy in SMARCA4-deficient NSCLC. <br /><br />The patient in this report was a 71-year-old man with a history of smoking and presented with a persistent cough. Imaging revealed a primary lesion in the right upper lobe and multiple metastatic lymph nodes. Biopsies confirmed the presence of poorly differentiated carcinoma cells that tended to form sarcomatoid carcinoma. Genetic testing showed the absence of driver alterations for lung cancer and mutations in TSC1, KMT2D, SMARCA4, and TP53. The patient had a high tumor mutation burden (TMB) and positive PD-L1 expression.<br /><br />Rather than opting for chemotherapy, the patient received pembrolizumab as a first-line treatment at a dose of 200mg intravenously every 3 weeks. After two doses, there was a noticeable reduction in tumor size, and subsequent imaging confirmed continuous lesion shrinkage. The patient had a partial response to treatment, and disease control has been maintained for over 12 months.<br /><br />The study concludes that anti-PD-1 antibodies, such as pembrolizumab, could be a promising treatment strategy for advanced SMARCA4-deficient lung sarcomatoid with a high TMB and positive PD-L1 expression. The findings suggest that immune checkpoint inhibitors may be effective in this specific subgroup of NSCLC patients.

Asset Subtitle

Youjun Deng

Meta Tag

Speaker Youjun Deng

Topic Metastatic NSCLC: Immunotherapy - Retrospective

Keywords

SMARCA4-deficient lung sarcomatoid

pembrolizumab

immune checkpoint inhibitor

SWI/SNF chromatin-remodeling complex

non-small cell lung cancer

carcinoma

sarcomatoid

genetic testing

tumor mutation burden

PD-L1 expression