Immune checkpoint inhibitors combined with targeted therapy for long-term survival in advanced pulmonary squamous cell carcinoma after first-line failure: A case report and literature review.

RATIONALE

Advanced squamous cell carcinoma (SCC) of the lung remains a major clinical challenge due to limited therapeutic options, particularly in the post-immunotherapy setting. Combining immune checkpoint inhibitors with small-molecule multi-targeted tyrosine kinase inhibitors that include anti-angiogenic effects offers a promising approach to overcome treatment resistance and improve survival outcomes.

PATIENT CONCERNS

A 44-year-old female with a 2-year history of recurrent cough and sputum production presented with worsening symptoms over the past month, including increased cough frequency and sputum volume. No significant systemic symptoms, such as hemoptysis or dyspnea, were reported.

DIAGNOSES

Chest computed tomography revealed a 35 mm × 31 mm mass in the right middle lung with enlarged supraclavicular and mediastinal lymph nodes. A biopsy confirmed the diagnosis of SCC. Staging was determined as cT3N3M1a (stage IVA), and genetic testing revealed no actionable driver mutations, while PD-L1 expression was 30% (tumor proportion score).

INTERVENTIONS

The patient initially received first-line treatment with pembrolizumab combined with docetaxel and nedaplatin, achieving partial response. After progression, second-line therapy included gemcitabine and cisplatin chemotherapy with synchronous radiotherapy, followed by camrelizumab and anlotinib. Regular imaging follow-ups guided therapy adjustments, including extended dosing intervals for camrelizumab during disease stabilization.

OUTCOMES

Over 4 years of treatment, the patient achieved durable partial response, with significant reduction in tumor burden and no new metastases. As of the most recent follow-up, the patient exhibited an overall survival of 59 months and progression-free survival of 51 months for second-line therapy, with manageable adverse effects including secondary hypothyroidism and grade 2 hypertension.

LESSONS

This case underscores the potential efficacy of combining immune checkpoint inhibitors with small-molecule multi-targeted tyrosine kinase inhibitors in treating advanced SCC of the lung after progression on first-line therapy. The complementary mechanisms of immune modulation and tumor microenvironment normalization may offer an effective strategy for addressing immune resistance in SCC.