A Case of Granulocyte-Colony-Stimulating Factor-Producing Non-Small Cell Lung Cancer under Steroid Treatment and with Poor Performance Status That Responded to Pembrolizumab.

Introduction: There have been only a few cases showing the efficacy of pembrolizumab on granulocyte-colony - stimulating factor (G-CSF)-producing non-small-cell lung cancer (NSCLC) with high programmed cell death ligand 1 (PD-L1) expression. Herein, we report the first case showing the efficacy of pembrolizumab for G-CSF-producing NSCLC with high PD-L1 expression, although the patient had factors indicative of poor pembrolizumab efficacy, such as poor performance status (PS) due to the tumor-induced inflammation and corticosteroids administration.
Case Presentation: A 77-year-old woman was diagnosed with G-CSF-producing NSCLC-not otherwise specified, classified as clinical stage IVB, T2N3M1c. She had fever and her PS was 3, and her C-reactive protein (CRP) was 6.47 mg/dL due to inflammation by a G-CSF-producing tumor. Thus, we initiated the administration of dexamethasone (3.3 mg/day). Her fever abated the next day, and CRP dropped to 3.22 mg/dL after 4 days. Driver mutations were negative, and PD-L1, tumor proportion score, was highly expressed at 100%. Thus, pembrolizumab was started. Subsequently, the white blood cell count decreased, and the tumor shrank, indicating a partial response. After three cycles of pembrolizumab therapy, the anorexia improved, and she was discharged. The patient developed sclerosing cholangitis after discharge. Therefore, the pembrolizumab treatment was discontinued. The primary lesion was enlarged, indicating progressive disease. However, the patient and her family did not want additional treatment. Finally, her progression-free survival and overall survival were 6 and 7 months, respectively.
Conclusion: Pembrolizumab may be effective against G-CSF-producing NSCLC with high PD-L1 expression. Corticosteroids seemed to inhibit inflammation induced by the tumor, and exert the efficacy of pembrolizumab.
Competing Interests: Takeshi Masuda reports personal fee from Daiichi-Sankyo Co., Ltd., Taiho Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Kyowa Kirin Co., Ltd., Eli Lilly Japan K.K., Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., and AstraZeneca K.K. outside the submitted work. Kakuhiro Yamaguchi reports honoraria from Ono Pharmaceutical Co., Ltd., outside the submitted work. Shinjiro Sakamoto reports honoraria from AstraZeneca K.K., Nippon Boehringer Ingelheim Co., Ltd., Chugai Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., and Novartis Pharma K.K. outside the submitted work. Yasushi Horimasu reports honoraria from Nippon Boehringer Ingelheim Co., Ltd., outside the submitted work. Taku Nakashima reports honoraria from AstraZeneca K.K. and Chugai Pharmaceutical Co., Ltd., outside the submitted work. Noboru Hattori reports honoraria from AstraZeneca K.K., Bristol Myers Squibb, Chugai Pharmaceutical Co., Ltd., and Ono Pharmaceutical Co., Ltd., outside the submitted work. No other disclosures are reported.
(© 2024 The Author(s). Published by S. Karger AG, Basel.)