Lucía Carril-Ajuria, Helena S. Gouveia, Elizabeth Jiménez-Aguilar, Ana Sánchez de Torre, Isabel Burgueño Lorenzo, Nerea Muñoz- Unceta, Santiago Ponce-Aix and Luis Paz-Ares
Background: Immune checkpoint inhibitors have emerged as a valuable therapeutic option in many types of advanced cancer, including small cell lung cancer. However, more research and data are still needed to understand how to better combine and sequence immunotherapy with classical chemotherapy agents in order to improve survival. Moreover, identifying and managing immune-related adverse events is still challenging.
Case presentation: We report a case of a recurrent small cell lung cancer. The patient was referred for inclusion in a clinical trial after progression of the disease despite two lines of therapy. After discontinuing both the nivolumab and ipilimumab treatment because of grade 3 hepatitis and grade 2 pneumonitis, and also after progression to a fourth line treatment with chemotherapy, the patient was rechallenged with compassionate use nivolumab monotherapy. This therapy was discontinued due to SOX1-positive dysarthria-clumsy-hand syndrome, which improved with corticosteroid therapy. After almost one year, the tumor remained stable reinforcing the idea that the cause of the complication was an immune-related encephalitis due to anti-PD1. Despite the severe toxicity, the patient achieved a long-term survival of almost four years.
Conclusion: The remarkable long-term survival obtained with immunotherapy rechallenge in this small cell lung cancer patient is promising for its future use in this setting characterized by a poor prognosis. However, immunotherapy rechallenge is not without risks. In fact, this is also the first case report on SOX1-positive autoimmune encephalitis due to anti-PD1. It also highlights the need of a careful diagnosis and therapy monitoring to prevent and mitigate potential irAEs.
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