{"title":"Long-survival of a patient with esophageal cancer benefited from comprehensive treatment and MDT: a case report.","authors":"Haojie Zhou, Lijie Tan, Yaxing Shen, Yin Jun, Tianshu Liu, Luoyan Ai","doi":"10.21037/jtd-24-227","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) are emerging as important drugs for patients with locally advanced esophageal cancer (EC). Yet, immune-related adverse events (irAEs) may be a major obstacle for these population. Multidisciplinary team (MDT) is an efficient way to deal with such conditions. The aim of this study is to report a case of a stage III esophageal squamous cell carcinoma (ESCC) patient who achieved long-term survival through comprehensive treatment and MDT management, despite multiple irAEs.</p><p><strong>Case description: </strong>A 67-year-old man was diagnosed with stage III ESCC (cT4N1M0) in January 2021. After 2 cycles of initial immuno-chemotherapy with good efficiency, he suffered from grade 3 immune-related hepatitis (IRH) and recovered after steroid therapy. Then radical radiotherapy began as planned. However, he got pneumonia and common antibiotics and steroid showed no effect. Finally, NGS-based pathogen detection identified cytomegalovirus (CMV) infection in his sputum. Ganciclovir was prescribed to him and his condition turned better soon. During a five-month period of anti-infectious therapy and follow-up, there was no anti-tumor treatment. However, the patient's esophageal lesion was evaluated as having a partial response (PR) on computed tomography (CT) scan and cancer cells transformed to high-grade intraepithelial neoplasia through gastroscopy. He underwent endoscopic submucosal dissection (ESD) and began a five-month follow-up period. When dysplasia recurred locally, the MDT members carefully restarted ICIs since he had fully recovered from previous irAEs and we believed he benefited from long-term responses to ICIs. Despite experiencing a third irAE, that is, adrenocortical insufficiency with mild symptoms, the patient still greatly benefited from ICIs. After being diagnosed as stage III EC for about 35 months, the patient's disease was still evaluated as clinical no evidence of disease (NED).</p><p><strong>Conclusions: </strong>EC patients with irAEs who are well managed benefited from ICIs. MDT is crucial in the management of comprehensive treatment for EC.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"8110-8116"},"PeriodicalIF":2.1000,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635259/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of thoracic disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/jtd-24-227","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/29 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Immune checkpoint inhibitors (ICIs) are emerging as important drugs for patients with locally advanced esophageal cancer (EC). Yet, immune-related adverse events (irAEs) may be a major obstacle for these population. Multidisciplinary team (MDT) is an efficient way to deal with such conditions. The aim of this study is to report a case of a stage III esophageal squamous cell carcinoma (ESCC) patient who achieved long-term survival through comprehensive treatment and MDT management, despite multiple irAEs.
Case description: A 67-year-old man was diagnosed with stage III ESCC (cT4N1M0) in January 2021. After 2 cycles of initial immuno-chemotherapy with good efficiency, he suffered from grade 3 immune-related hepatitis (IRH) and recovered after steroid therapy. Then radical radiotherapy began as planned. However, he got pneumonia and common antibiotics and steroid showed no effect. Finally, NGS-based pathogen detection identified cytomegalovirus (CMV) infection in his sputum. Ganciclovir was prescribed to him and his condition turned better soon. During a five-month period of anti-infectious therapy and follow-up, there was no anti-tumor treatment. However, the patient's esophageal lesion was evaluated as having a partial response (PR) on computed tomography (CT) scan and cancer cells transformed to high-grade intraepithelial neoplasia through gastroscopy. He underwent endoscopic submucosal dissection (ESD) and began a five-month follow-up period. When dysplasia recurred locally, the MDT members carefully restarted ICIs since he had fully recovered from previous irAEs and we believed he benefited from long-term responses to ICIs. Despite experiencing a third irAE, that is, adrenocortical insufficiency with mild symptoms, the patient still greatly benefited from ICIs. After being diagnosed as stage III EC for about 35 months, the patient's disease was still evaluated as clinical no evidence of disease (NED).
Conclusions: EC patients with irAEs who are well managed benefited from ICIs. MDT is crucial in the management of comprehensive treatment for EC.
期刊介绍：
The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.
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