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. 2020 Apr 7:22:83-87.
doi: 10.1016/j.ctro.2020.04.003. eCollection 2020 May.

PD-L1 induction in tumor tissue after hypofractionated thoracic radiotherapy for non-small cell lung cancer

Jaanika Narits  1 , Hannes Tamm  2   3 , Jana Jaal  1   4
Affiliations

PD-L1 induction in tumor tissue after hypofractionated thoracic radiotherapy for non-small cell lung cancer

Jaanika Narits et al. Clin Transl Radiat Oncol. .

Abstract

We report on a 67-year old male with advanced stage lung adenocarcinoma (initially PD-L1 negative, EGFR and ALK negative) diagnosed in 2014. The patient received 4 lines of palliative chemotherapy from 2014 to 2017, however the disease progressed. In 2015, he also received palliative hypofractionated radiotherapy to a mediastinal mass, which was causing discomfort and pain. Since there was some data, that radiotherapy could induce PD-L1 expression, a new biopsy was taken in 2017 from the irradiated mediastinal mass. Subsequent pathologic report revealed that PD-L1 status was turned to be highly positive, with tumor proportion score of 100%. Similar high expression of PD-L1 was detected in a new metastasis in the duodenum, which was excised due to a duodenal perforation in 2017. From October 2017 to October 2019, the patient had 2-years of treatment (32 courses) with pembrolizumab and has had a positive effect (partial response) on all the lesions and following stabilization of the disease. Currently, this patient is under follow up and he is in a good condition without any complaints. Last CT-scan in March 2020 showed persisting partial response.

Keywords: Metastases; Nsclc; PD-L1; Pembrolizumab; Radiotherapy.

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Figures

Fig. 1
Fig. 1
Immunohistochemical staining of programmed death ligand-1 (PD-L1) in lung adenocarcinoma. Immunostaining was performed using 22C3 antibody and VENTANA BenchMark ULTRA platform. A: Initially PD-L1 negative tumor tissue (excised supraclavicular lymph node 2.5 × 1.5 × 1 cm, PD-L1 TPS < 1%, magnification x200), arrows indicate nests of PD-L1 negative tumor cells; B: PD-L1 highly positive tumor tissue after hypofractionated radiotherapy (transthoracic needle biopsy from previously irradiated mass in upper mediastinum, ca 0.5 cm, PD-L1 TPS 100%, magnification x100); C: PD-L1 highly positive metastasis in small intestine (resected duodenal metastatic mass ca 3 cm, PD-L1 TPS 100%, magnification x400).
Fig. 2
Fig. 2
The timeline of patient treatments.
Fig. 3
Fig. 3
Radiotherapy treatment plan for upper mediastinal mass Patient received hypofractionated radiotherapy, 45 Gy total in 15 fractions.
See this image and copyright information in PMC

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References

    1. Innos K., Oselin K., Laisaar T., Aareleid T. Patterns of survival and surgical treatment in lung cancer patients in Estonia by histologic type and stage, 1996–2016. Acta Oncol. 2019;1–8 - PubMed
    1. Planchard D, Popat S, Kerr K, Novello S, Smit EF, Faivre-Finn C, et al. Metastatic non-small cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology: official journal of the European Society for Medical Oncology. 2018;29:iv192-iv237. - PubMed
    1. Gandhi L., Rodriguez-Abreu D., Gadgeel S., Esteban E., Felip E., De Angelis F. Pembrolizumab plus Chemotherapy in Metastatic Non-Small-Cell Lung Cancer. New England J Med. 2018;378:2078–2092. - PubMed
    1. Rodrigues G., Videtic G.M., Sur R., Bezjak A., Bradley J., Hahn C.A. Palliative thoracic radiotherapy in lung cancer: an American Society for Radiation Oncology evidence-based clinical practice guideline. Pract Radiat Oncol. 2011;1:60–71. - PMC - PubMed
    1. Gomez D.R., Tang C., Zhang J., Blumenschein G.R., Jr., Hernandez M., Lee J.J. Local Consolidative Therapy Vs. Maintenance Therapy or Observation for Patients With Oligometastatic Non-Small-Cell Lung Cancer: Long-Term Results of a Multi-Institutional, Phase II, Randomized Study. J Clin Oncol. 2019;37:1558–1565. - PMC - PubMed