Surgery for primary lung cancer of right upper lobe during pembrolizumab administration for Stage IV lung cancer of right lower lobe

• Published in: Nihon Kokyuki Geka Gakkai zasshi (Kyoto, 1992) Vol. 37; no. 5; pp. 426 - 431
• Main Authors: Morohoshi, Naoki, Kawahara, Yoichiro, Tao, Yoshihiro, Hayashi, Kozo, Hosokawa, Yoshio
• Format: Journal Article
• Language: English; Japanese
• Published: The Japanese Association for Chest Surgery 15.07.2023
• Subjects: immune checkpoint inhibitor; metachronous ipsilateral other lobe lung cancer
• ISSN: 0919-0945; 1881-4158
• DOI: 10.2995/jacsurg.37.426

The subject was a 63-year-old male. Three years previously, he had been diagnosed with right lower lobe pulmonary adenocarcinoma, accompanied by multiple sites of brain metastasis and right adrenal metastasis. Following cerebral tumor removal and cranial irradiation, treatment using pembrolizumab was started. During the first course of treatment, pneumonia occurred in the right upper lobe, and an area of irregular ground-glass opacity remained even after treatment. After 9 courses of treatment, the primary lesion decreased to 0.6 cm, and all metastatic lesions disappeared. After 48 courses of treatment, the area of ground-glass opacity which remained in the right upper lobe suddenly increased in size. A transbronchial biopsy showed glandular cancer with a different form than that of the right lower lobe pulmonary cancer, and this was suspected to be secondary cancer. Regarding the right lower lobe pulmonary cancer, a partial response was maintained by immunotherapy. As a result, surgery was performed for the right upper lobe pulmonary cancer, with the goal of achieving long-term survival. The #12L lymph node that had become swollen and had been identified at the first visit had changed into scar-like tissue that had attached itself to the right upper lobe and pulmonary trunk, which made it difficult to remove. Therefore, the right upper lobe was removed while dividing the lymph nodes in question along with the pulmonary trunk. Transitory atrial fibrillation was confirmed on the fifth day with no other complications, and the patient was discharged from the hospital on the tenth day. The pathological findings confirmed the cancer to be right upper lobe pulmonary adenocarcinoma ypT1cN1MX.