Octreotide plus IBI-318 plus anlotinib in the treatment of multiple neuroendocrine metastases of unknown primary lesions: a case report

Haoyue Qin; Huan Yan; Xing Zhang; Zhe Huang; Yangqian Chen; Yuda Zhang; Siqi Xiang; Yongchang Zhang; Nong Yang; Liang Zeng

doi:10.3389/fonc.2024.1390299

Octreotide plus IBI-318 plus anlotinib in the treatment of multiple neuroendocrine metastases of unknown primary lesions: a case report

Front Oncol. 2024 Dec 11:14:1390299. doi: 10.3389/fonc.2024.1390299. eCollection 2024.

Authors

Haoyue Qin¹, Huan Yan^{1

2}, Xing Zhang^{1

2}, Zhe Huang^{1

2}, Yangqian Chen^{1

2}, Yuda Zhang^{1

2}, Siqi Xiang², Yongchang Zhang^{1

2}, Nong Yang^{2

3}, Liang Zeng^{1

2}

Affiliations

¹ Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, China.
² Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
³ The Cancer Center, The Second People's Hospital of Hunan Province/The School of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, China.

Abstract

Background: The second-line treatment of neuroendocrine tumors (NETs) of unknown primary origin remains uncertain. This report presented a patient who received octreotide plus IBI-318 plus anlotinib as a second-line treatment for multiple metastatic NETs of unknown primary lesions after the failure of octreotide plus everolimus.

Case presentation: A 32-year-old male patient presented with elevated CEA (197.83 ng/ml) without specific symptoms. A contrast-enhanced computed tomography (CT) scan showed multiple metastatic lymph nodes and multiple low-density nodules in the liver of undetermined nature. A right supraclavicular lymph node biopsy indicated NET, but the primary tumor origin remained unknown. PD-L1 expression was negative in tumor tissue according to immunohistochemistry. Immunofluorescence indicated the CD4⁺ T cells, CD8⁺ T cells, and Treg cells were gathered around blood vessels, with only a few infiltrating lymphocytes in the tumor tissue. Treatment with octreotide (30 mg/28 d) plus everolimus (5 mg qd) led to disease progression after three cycles. Treatment was changed to octreotide (30 mg/28 d) plus IBI318 (400 mg/28 d) plus anlotinib (10 mg/1-14 d/q3w), leading to partial remission, which was sustained up to the last follow-up (June 20, 2023), with a PFS of 11 months. The patient experienced no treatment-related adverse reactions.

Conclusions: Octreotide plus IBI318 plus anlotinib achieved benefits in a patient with advanced NETs of unknown primary lesions after first-line treatment failure, even though with low PD-L1 expression. This case suggests that combining SSAs, TKIs and PD-1/PD-L1 inhibitors could be an alternative second-line treatment for patients with advanced, well-differentiated NETs.

Keywords: IBI-318; anlotinib; metastases; neuroendocrine tumors; octreotide.

Publication types

Case Reports

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study was supported by the Natural Science Foundation of Hunan Province (grant numbers: 2021RC3118, 2021SK51105, 2023JJ30368, and 2020NSFC-A002); Guangdong Association of Clinical Trials (GACT)/Chinese Thoracic Oncology Group (CTONG) and Guangdong Provincial Key Lab of Translational Medicine in Lung Cancer (grant number: CTONG-YC20200203).