Electronic ISSN 2287-0237

VOLUME

CASE REPORT: METASTATIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA SUCCESSFULLY TREATED WITH IMMUNOTHERAPY: FIRST CASE REPORT IN THAILAND.

SEPTEMBER 2016 - VOL.12 | CASE REPORT

Metastatic esophageal carcinoma is considered one of the worst prognosis cancers worldwide. The goals of treatment are usually symptoms palliation and possible life prolongation. In recent years, the field of immuno-oncology has shown promising treat- ment results and caused a paradigm shift in many types of cancer, as the response is quite long-lasting. Anti-programmed cell death 1 (anti PD-1) is one of the immuno-oncology drugs which has been investigated in many types of cancer and currently has been approved to be used in melanoma, lung cancer, kidney cancer and bladder cancer. We report a case of metastatic esophageal squamous cell carcinoma which had been heavily pretreated but presented an almost complete response to the anti PD-1, pembrolizumab.

 

Keywords:

immunotherapy,anti PD-1 blockage,pembrolizumab,esophagus,metastatic cancer

 

MEDIA
Figure 1:
The esophageal mucosa reveals a group of poorly differentiated malignant epithelial cells in the tissue which is likely to be squamous cell, carcinoma, poorly differentiated.
Figure 2:
PET/CT at the initial diagnosis suggestive of primary cancer at lower thoracic esophagus with lymph node metastases at paraesophageal nodes, left upper paratracheal and paragastric cardial regions, distant metastases at liver, bone and left adrenal gland.
Figure 3:
PET/CT after concurrent chemoradiation revealed marked regressed the hypermetabolic circumferential tumor of mid to lower esophagus. Progress metabolic activity with unchanged size of lymph nodes at right paraesophageal nodes and also new found hypermetabolic left adrenal mass. Progressed metabolic metastasis at left 4th rib.
Figure 4.1:
Shows H&E.
Figure 4.2:
Shows PD-1 immunohistochemistry.
Figure 4.3:
Shows PD-L1 immunohistochemistry.
Figure 5:
PET/CT after 9 cycles of pembrolizumab (27 weeks of treatment) showed markedly regressed metabolic activity of the pre-existing node metastasis at right paraesophageal areas. Disappearance of hypermetabolic activity at left adrenal gland and left rib are observed.
Figure 6:
: Shows the PD-1 pathway in suppressing anti-tumor immunity.
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