Neoadjuvant immunotherapy for elderly patients with non-small-cell lung cancer: a case report and literature review

Although neoadjuvant immunotherapy has achieved remarkable results in the treatment of lung cancer, it is still infrequently applied in geriatric patients. We report on a 76-year-old male patient with a long-term history of heavy smoking presenting with cough and hemolysis. There was no related underlying disease or positive findings on physical examination. On July 23, 2019, his chest computed tomography (CT) showed small nodules in the upper lobe of the right lung and multiple enlarged lymph nodes in the mediastinum. Fiberoptic bronchoscopy showed a neoplasm in a subsegment of the upper lobe of the right lung. Following biopsy the patient was diagnosed with squamous cell carcinoma of the right upper lung, with lymph node metastasis in the mediastinum (CT1N2M0, IIIA). Between late July and mid-August of 2019, he received chemotherapy (TP regimen) combined immunotherapy for 2 cycles of preoperative neoadjuvant therapy. Three weeks later he underwent chest CT re-examination which revealed his focus was significantly shrunken in size, and multiple lymph nodes in the mediastinum and right hilum were smaller in comparison to the first examination. The patient then underwent thoracoscopic radical resection of the right upper lung cancer under general anesthesia and recovered uneventfully after surgery. The postoperative pathology examination showed complete response and no signs of recurrence were discovered on the 6 months follow up during which time the patient received immunotherapy on a monthly basis. We report on a case of immunotherapy in a geriatric patient with literature review which supports new treatment strategies for the treatment of elderly patients with lung cancer.