2024 World Conference on Lung Cancer (WCLC) - ePosters-EP.11E.06 "Down-Stage" To Thoracic Surgery after Neoadjuvant Immunochemotherapy

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A 59-year-old male with a history of heavy smoking was diagnosed with stage IIb squamous cell lung cancer in the right upper lobe, with lymph node metastasis but no distant spread. Presented with chronic cough and bloody sputum, his diagnosis was confirmed through various imaging techniques and biopsies, revealing a PD-1 expression level of over 40%. The multidisciplinary team planned a complex surgery initially but opted for two cycles of neoadjuvant immunochemotherapy to reduce surgical risks and post-operative complications. The chemotherapy regimen included carboplatin, albumin paclitaxel, and Sintilimab, aiming to shrink the tumor before surgery.<br /><br />Following the neoadjuvant treatment, a follow-up bronchoscope and CT scan showed a significant reduction in tumor size, leading to a reevaluation of the surgical approach. The tumor shrank from 3.1 cm to 2.5 cm and was categorized as yp-T1N0M0 stage Ia after the therapy, indicating a partial response (PR) and a major pathologic response (MPR), with less than 10% of the tumor remaining and no residual cancer in the lymph nodes. The surgery proceeded with a right upper lobectomy and systematic lymph node dissection, involving minimal blood loss and a smooth recovery period.<br /><br />The patient showed excellent perioperative outcomes, with no reported complications and a short hospital stay. Intraoperatively, cryopathology confirmed a negative surgical margin. Over the subsequent seven months of follow-up, the patient experienced no recurrence or metastasis, suggesting a positive long-term prognosis. This case illustrates that neoadjuvant immunochemotherapy can effectively "down-stage" the cancer, simplifying surgical procedures while maintaining oncological efficacy and improving postoperative outcomes.

Asset Subtitle

Ningyuan Zou

Meta Tag

Speaker Ningyuan Zou

Topic Metastatic Non-small Cell Lung Cancer – Immunotherapy

Keywords

squamous cell lung cancer

neoadjuvant immunochemotherapy

PD-1 expression

carboplatin

albumin paclitaxel

Sintilimab

right upper lobectomy

major pathologic response

lymph node metastasis

down-stage cancer