CASE STUDIES
State-of-the-Art Immunotherapy Treatment for Stage IV Cancer, with Quality of Life in Mind
Provided By:
Talat Almukthar, MDPatient History
A 74-year-old Caucasian male with past medical history of double vision, peripheral neuropathy and chronic kidney disease (CKD) presented to The Oncology Institute of Hope & Innovation due to bilateral pulmonary nodules and metastatic retroperitoneal lymph node (LN). PET CT scan showed multiple pulmonary nodules in both lungs, hypermetabolic LN in the left hilum, and in the retroperitoneum on the right, consistent with metastatic disease. He underwent biopsy of the retroperitoneal LN that confirmed metastatic cytokeratin- positive carcinoma. He was diagnosed of stage IV Carcinoma of Unknown Primary. Molecular testing showed “high tumor mutational burden”, indicating high total number of mutations found in the DNA of cancer cells.
Treatment Plan
Because of the patient’s peripheral neuropathy and CKD, he was not a candidate for chemotherapy. Our goal was treating his cancer, but at the same time, maintaining his quality of life. Studies have shown that cancers with high number of mutations appear to be more likely to respond to immunotherapy. Therefore, we treated him with an immunotherapy medication called pembrolizumab (Keytruda®). Treatment was given at our infusion center every 3 weeks.
Results
The patient received 5 cycles of treatment that were tolerated very well. Follow up PET CT scan four months later showed that the previously seen metabolically active pulmonary nodules, hilar, mediastinal lymph nodes and retroperitoneal lymph nodes had resolved. This was consistent with complete remission of his stage IV cancer. The patient continues his treatment and enjoys a high quality of life with his family.
