A case of dramatic reduction in cancer-associated thrombus following initiation of pembrolizumab in patient with a poor performance status and PD-L1+ lung adenocarcinoma harboring CCDC6-RET fusion gene and NF1/TP53 mutations

Takamasa Nakasuka; Kadoaki Ohashi; Hiromi Watanabe; Toshio Kubo; Shingo Matsumoto; Koichi Goto; Katsuyuki Hotta; Yoshinobu Maeda; Katsuyuki Kiura

doi:10.1016/j.lungcan.2021.03.022

A case of dramatic reduction in cancer-associated thrombus following initiation of pembrolizumab in patient with a poor performance status and PD-L1⁺ lung adenocarcinoma harboring CCDC6-RET fusion gene and NF1/TP53 mutations

Lung Cancer. 2021 Jun:156:1-4. doi: 10.1016/j.lungcan.2021.03.022. Epub 2021 Apr 7.

Authors

Takamasa Nakasuka¹, Kadoaki Ohashi², Hiromi Watanabe¹, Toshio Kubo³, Shingo Matsumoto⁴, Koichi Goto⁴, Katsuyuki Hotta⁵, Yoshinobu Maeda¹, Katsuyuki Kiura⁶

Affiliations

¹ Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan.
² Department of Respiratory Medicine, Okayama University Hospital, Okayama, 700-8558, Japan. Electronic address: kohashi@cc.okayama-u.ac.jp.
³ Center for Clinical Oncology, Okayama University Hospital, Okayama, 700-8558, Japan.
⁴ Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, 277-8577, Japan.
⁵ Department of Respiratory Medicine, Okayama University Hospital, Okayama, 700-8558, Japan; Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, 700-8558, Japan.
⁶ Department of Respiratory Medicine, Okayama University Hospital, Okayama, 700-8558, Japan.

PMID: 33845248
DOI: 10.1016/j.lungcan.2021.03.022

Abstract

Objectives: Pembrolizumab is a standard treatment for non-small cell lung cancer (NSCLC) with high-PD-L1 expression; however, its effect is dismal in patients with poor physical condition. Additionally, the effect of immunotherapy is generally limited in NSCLC harboring driver mutations such asEGFR, ALK, or RET gene aberrations.

Results: We report the beneficial effect of pembrolizumab in a patient with poor performance status and PD-L1+ lung adenocarcinoma with theCCDC6-RET fusion gene and co-occurring NF1/TP53 mutations, complicated by multiple cancer-associated thrombi and respiratory failure.

Conclusions: Further studies are warranted to establish the role of co-occurring NF1/TP53 mutations as a positive predictive biomarker for pembrolizumab in NSCLC harboring RET fusion genes.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma of Lung* / complications
Adenocarcinoma of Lung* / drug therapy
Adenocarcinoma of Lung* / genetics
Antibodies, Monoclonal, Humanized
B7-H1 Antigen / metabolism
Biomarkers, Tumor
Carcinoma, Non-Small-Cell Lung* / complications
Carcinoma, Non-Small-Cell Lung* / drug therapy
Carcinoma, Non-Small-Cell Lung* / genetics
Cytoskeletal Proteins
Humans
Lung Neoplasms* / complications
Lung Neoplasms* / drug therapy
Lung Neoplasms* / genetics
Mutation
Proto-Oncogene Proteins c-ret / genetics
Thrombosis*
Tumor Suppressor Protein p53 / genetics

Substances

Antibodies, Monoclonal, Humanized
B7-H1 Antigen
Biomarkers, Tumor
CCDC6 protein, human
Cytoskeletal Proteins
TP53 protein, human
Tumor Suppressor Protein p53
pembrolizumab
Proto-Oncogene Proteins c-ret
RET protein, human