Case Report: Recombinant Human Endostatin Plus Chemotherapy for Epidermal Growth Factor Receptor-Negative Miliary Lung Adenocarcinoma

Abstract

Except for the traditional chemotherapy, few treatments strategy about miliary intrapulmonary carcinomatosis (MIPC) have been reported in the existing literature. In this report, we primarily discussed the possible etiology and the potentially effective treatment options for a patient with MIPC who benefited from combined treatment. A nonsmoking woman was diagnosed with MIPC at an advanced stage. Gene detection showed an EGFR negative status. She accepted first-line chemotherapy with pemetrexed and cisplatin, and the tumor progressed. Next, PD-1 inhibitors plus pemetrexed and cisplatin were administered, and the tumor remained uncontrolled. After two cycles of recombinant human endostatin plus second-line chemotherapy, the numerous pulmonary nodules had all nearly completely disappeared, while an accentuated decrease in the primary tumor volume was observed. Moreover, biochemical markers, including the patient's tumor markers, also trended toward normal. This report describes the first case of a MIPC patient who significantly responded to antiangiogenic therapy combined with chemotherapy. Anti-angiogenic therapy may be a possible strategy for the EGFR-negative lung adenocarcinoma population.

Keywords: anti-angiogenic therapy; immunotherapy; lung adenocarcinoma; miliary metastasis; recombinant human endostatin.

Figure 1

Imagines of computed tomography (CT) and Magnetic resonance (MR) before treatment. (A) Chest CT scan with lung window; (B) Chest CT scan with mediastinal window; (C) Abdominal-enhanced CT scan; (D) Head magnetic resonance (MR) image. Imagines of CT after the first cycle of pemetrexed and cisplatin. (E) Chest CT scan with lung window; (F) Abdominal CT scan; Imagines of CT after three cycles of Sintilimab combined with pemetrexed and cisplatin. (G) Chest CT scan with lung window; (H) Abdominal CT scan; Imagines of computed tomography (CT) and Magnetic resonance (MR) after two cycles of Endostar combined with docetaxel and lobaplatin. (I) Chest CT scan with lung window; (J) Chest CT scan with mediastinal window; (K) Abdominal-enhanced CT scan; (L) Head magnetic resonance (MR) image. These imagines were showed the timeline of different treatments for the patient’s entire treatment progression.

Figure 2

The line charts of tumor biomarkers during the treatment period. (A) CEA; (B) NSE; (C) CYFRA21-1.

Figure 3

Lesion biopsy specimen of the left supraclavicular lymph node. (A) HE × 100; (B) TTF-1× 100; (C) Ki-67 × 100; (D) Syn × 100; (E) P40 × 100; (F) PD-L1 × 100.