Hyperprogressive Disease After Immunotherapy: A Case Report of Pulmonary Enteric Adenocarcinoma

• Published in: Frontiers in Oncology
• Main Authors: Chun-Hong Hu, Shenghao Shi, Wen Dong, Lizhi Xiao, Hongjing Zang, Fang Wu
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2022-03-01
• Subjects: pulmonary enteric adenocarcinoma; chemotherapy; immunity therapy; hyperprogressive disease; case report
• Online Access: https://www.frontiersin.org/articles/10.3389/fonc.2022.799549/full

Primary pulmonary enteric adenocarcinoma (PEAC) is a rare invasive adenocarcinoma clinically similar to metastatic colorectal adenocarcinoma (MCRC). Although many studies have addressed the differential diagnosis of PEAC, few have described the treatment of PEAC, especially using immunotherapy. This report describes a 61-year-old man who presented initially with pain in the ribs. Pathological analysis of biopsy samples shows malignant tumors of the right pleura, and next-generation sequencing of 26 genes showed a KRAS gene mutation. Positron emission tomography-computed tomography (PET-CT) found no evidence of gastrointestinal malignancy. Due to multiple metastases, the patient could not undergo radical surgery. The patient was treated with a combination chemotherapy regimen of paclitaxel plus carboplatin, along with sindilizumab immunotherapy, but, after one cycle of treatment, the tumor showed a hyperprogressive state. The patient is still being monitored regularly. These findings indicate that chemotherapy combined with immunotherapy may be ineffective in the treatment of primary PEAC with positive driver genes.