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Case Reports
. 2018 Sep 7:11:5601-5605.
doi: 10.2147/OTT.S168598. eCollection 2018.

Pembrolizumab and salvage chemotherapy in EGFR T790M-positive non-small-cell lung cancer with high PD-L1 expression

Takehiro Tozuka  1 , Masahiro Seike  1 , Yuji Minegishi  1 , Shingo Kitagawa  1 , Tomomi Kato  1 , Natsuki Takano  1 , Kakeru Hisakane  1 , Satoshi Takahashi  1 , Kenichi Kobayashi  1 , Takeru Kashiwada  1 , Teppei Sugano  1 , Susumu Takeuchi  1 , Shinobu Kunugi  2 , Rintaro Noro  1 , Yoshinobu Saito  1 , Kaoru Kubota  1 , Akihiko Gemma  1
Affiliations
Case Reports

Pembrolizumab and salvage chemotherapy in EGFR T790M-positive non-small-cell lung cancer with high PD-L1 expression

Takehiro Tozuka et al. Onco Targets Ther. .

Abstract

Immuno-checkpoint inhibitors (ICI) have become an effective treatment option for non-small-cell lung cancer patients. However, ICI therapy was reported to be less effective in patients with epidermal growth factor receptor (EGFR) mutations than in those with wild-type EGFR. We report here that an non-small-cell lung cancer patient with the EGFR mutant T790M showed a programmed cell death ligand 1 (PD-L1) expression level that increased from <25% to >90% after eighth-line osimertinib therapy. He was treated with pembrolizumab as a ninth-line treatment, and attained stable disease. After the pembrolizumab therapy, he was treated with gemcitabine, which produced a good response despite being the 10th-line treatment. We should consider administering ICI and chemotherapy even to EGFR mutant patients after failure of EGFR tyrosine kinase inhibitor, especially in cases with high PD-LI expression.

Keywords: chemotherapy post immunotherapy; epidermal growth factor receptor mutation; lung cancer; programmed cell death ligand 1.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) Immunohistochemical staining (IHC) of programmed cell death ligand 1 (PD-L1) from biopsy specimens after treatment with osimertinib as the eighth-line treatment showed PD-L1 tumor proportion score (TPS) ≧90%. (B) IHC of PD-L1 from surgical specimens before chemotherapy and epidermal growth factor receptor tyrosine kinase inhibitors showed PD-L1 TPS 1%–24%.
Figure 2
Figure 2
Pembrolizumab followed by gemcitabine therapy showed antitumor effects. Notes: Chest computed tomography scan images obtained before administration of pembrolizumab (A, B) and at 2 months after three cycles of pembrolizumab showing stable disease (C, D) and after 2 months of administration of gemcitabine showing a partial response (E, F). Arrowheads indicate pulmonary metastatic lesions.
See this image and copyright information in PMC

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