Abstract
Background
The use of anti-PD-1 or PD-L1 inhibitors in combination with other anti-cancer agents was a priority for treating advanced non-small cell lung cancer (NSCLC) patients with considerable PD-L1 expression. However, studies seldom show the progression of liver metastases after using immune checkpoint inhibitors (ICIs).
Methods
Data were obtained from the Department of Pulmonary and Critical Care of Medicine, the First Affiliated Hospital of the Air Force Military Medical University. In the present study, we analyzed five non-small cell lung cancer (NSCLC) patients who had liver metastases after they were treated with pembrolizumab between 2019 and 2021. All of them had both stable primary lesions and liver progression with pembrolizumab intervention. Blood laboratory tests and imaging examinations were performed regularly during the treatment to assess the tumor responses of patients.
Results
All patients displayed reduction or stability in the initial lesions as a result, but they also experienced the emergence of metastatic liver locations, which were regularly detected throughout immunotherapy. Additionally, the appearance of liver metastasis weakened their liver function gradually with the escalation of carcinoembryonic antigen, regarded as a predictor for evaluating the progression of tumors. These individuals were highly distinctive with hyper-progressive diseases associated with immunotherapy. We drew individualized intervention schemes for metastatic lesions in each patient and found that their life expectancy shared no significance given the restricting subjected population.
Conclusions
Our study indicated a clinical phenomenon after using immune checkpoint inhibitors and presented a necessity for implementing large scales clinical studies to manage NSCLC-oriented liver metastasis.
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Data availability
All data generated or analyzed in this study were oriented from a standardized clinical process and included in this published article.
Abbreviations
- ICIs:
-
Immune checkpoint inhibitor
- NSCLC:
-
Non-small cell lung cancer
- SCLC:
-
Small cell lung cancer
- PD-1:
-
Programmed cell death-1
- PD-L1:
-
Programmed cell death-ligand 1
- CT:
-
Computed tomography
- PET:
-
Positron emission tomography
- NGS:
-
Next-generation sequencing
- IHC:
-
Immunohistochemical
- PFS:
-
Progression-free survival
- OS:
-
Overall survival
- BLM:
-
Before liver metastasis
- LM:
-
Liver metastasis
- AFM:
-
After liver metastasis
- TACE:
-
Transhepatic arterial chemotherapy and embolization
- RFA:
-
Radiofrequency ablation
- SABR:
-
Stereotactic ablative radiotherapy
- WBRT:
-
Whole brain radiation therapy
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Acknowledgements
The authors thank Pro. Lu Wang for her assistance in evaluating pathological diagnosis. We also thank Pro. Hong Yin and Pro. Xue Gong for their altruistic help in sharing knowledge in imaging and ultrasound.
Funding
This study was funded by grants from the Booster project of the Air Force Military Medical University (#2021LC2115) and the National Natural Science Foundation of China (#81902316).
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DQ and HX collected the relative information from patients and analyzed these data; MW was responsible for the calibration of the data and its follow-up; PJ, NC, XY, and YZ presented the indicated cases with original data; ZR was responsible for statistical analysis; XC helped to diagnose liver metastasis with professional assistance. YZ described the typesetting and wrote the manuscript; JZ presented the concept and design. All authors had read and approved the final manuscript.
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This study was approved by the Ethics Committee of the First Affiliated Hospital of the Air Force Medical University. Clinical cases included in this paper have signed informed consent based on the voluntary principle.
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Qiu, D., Xi, H., Wang, M. et al. The debatable role of immune checkpoint blockade therapy in lung adenocarcinoma-oriented liver metastatic malignant lesions. J Cancer Res Clin Oncol 149, 5791–5802 (2023). https://doi.org/10.1007/s00432-022-04538-5
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DOI: https://doi.org/10.1007/s00432-022-04538-5