A patient with advanced lung squamous cell carcinoma who failed to benefit from albumin bound paclitaxel plus pembrolizumab achieved partial response with second-line treatment of docetaxel plus pembrolizumab: a case report

Background: Lung cancer, including squamous cell lung cancer and non-squamous non-small cell lung cancer (NSCLC), is the leading cause of cancer-related deaths. At present, for squamous cell lung cancer patients who have progressed on first-line chemotherapy plus immunotherapy, immunotherapy applied across the line is still inconclusive. Therefore, treatment for such patients is often challenging.

Case description: We present a 53-year-old male patient who found lung mass in August 2021, without symptoms of cough, expectoration or hemoptysis. Through imaging examinations, we found he got tumor of upper lobe in right lung, with left lung metastasis and lymph node metastasis in the right hilar. Bronchoscopy biopsy showed poorly differentiated squamous cell carcinoma of the right lung. Gene screening showed TP53 mutation. The patient was diagnosed as stage IVA (cT2aN1M1b) squamous cell carcinoma. He was administered four cycles of first-line albumin-binding paclitaxel + carboplatin combined with pembrolizumab. Reexamination of chest CT (2022-01-10) showed both right lung lesions and right hilar lymph nodes were progressed after progression free survival (PFS) of four months. After received two cycles of second-line therapy (docetaxel + carboplatin combined with pembrolizumab), the lung lesions shrunk significantly with efficacy of partial response (PR). As of 2022-05-18, he received a total of five cycles of second-line regimen. During this period, the disease was stable. No adverse events related to chemotherapy or immunotherapy were observed during the treatment. This is the first report of a successful case with an advanced lung squamous cell carcinoma patient who achieved disease remission after first-line progressed disease and second-line immunotherapy combined with chemotherapy. This case suggests that for such patients who fail to response to the first-line albumin-bound paclitaxel combined with immunotherapy, may get favorable response to docetaxel combined with immunotherapy. We need further investigations to validate that.

Conclusions: This case suggested advanced lung squamous cell carcinoma patients who have failed to respond to first-line albumin paclitaxel combined with immunotherapy may still benefit from second-line docetaxel combined with immunotherapy. In addition, presentation of the TP53 mutation may be useful in predicting patients who may be responsive to docetaxel plus immunotherapy.