Clinical Report: Prolonged Survival in Advanced PD-L1-High Squamous Cell Lung Carcinoma

Overview

This case study highlights a 58-year-old male with advanced squamous cell lung carcinoma who experienced severe immune-related myocarditis after immunotherapy but achieved prolonged survival with subsequent anti-angiogenic therapy. The patient demonstrated a progression-free survival of 31 months and an overall survival of 43 months following treatment adjustments.

Background

Lung cancer remains the leading cause of cancer-related mortality globally, with non-small cell lung cancer (NSCLC) comprising a significant portion of these cases. The introduction of immune checkpoint inhibitors (ICIs) has improved outcomes for patients with advanced NSCLC, particularly those with high PD-L1 expression. However, severe immune-related adverse events, such as cardiotoxicity, complicate treatment and necessitate careful management strategies.

Data Highlights

Key Findings

• A 58-year-old male with stage IVA squamous cell lung carcinoma developed grade 3 immune-mediated myocarditis post-chemoimmunotherapy.
• Permanent discontinuation of ICIs was required due to severe cardiotoxicity.
• After recovery from myocarditis, the patient received anlotinib, achieving a progression-free survival of 31 months.
• The overall survival of the patient was 43 months despite the initial severe adverse event.
• This case suggests that anti-angiogenic therapy can be safely administered following recovery from severe immune-related cardiotoxicity.

Clinical Implications

This case underscores the importance of personalized treatment approaches for patients who experience severe immune-related adverse events. Clinicians should consider alternative therapies, such as anti-angiogenic agents, for managing advanced lung cancer in patients recovering from cardiotoxicity.

Conclusion

The successful management of severe immune-related cardiotoxicity in this patient illustrates the potential for prolonged survival in advanced lung cancer with high PD-L1 expression through tailored treatment strategies.

References

1. The ASCO Post, 2025 -- Some Patients With Advanced NSCLC Experience Durable Disease Control After Immunotherapy Discontinuation
2. The ASCO Post, 2020 -- Multisystem Immune-Related Adverse Events and Disease Outcomes Among Patients With NSCLC Treated With Immunotherapy
3. The ASCO Post, 2017 -- Five-Year Survival Quadrupled in Responders to Immunotherapy for Non–Small Cell Lung Cancer
4. Basic Research in Cardiology, 2021 -- Cardiac Impairment Associated with Cancer and Its Treatments: Emerging Strategies for Preventing Long-Term Cardiotoxic Effects
5. Updated treatment recommendations for systemic treatment: from the ESMO non-oncogene-addicted metastatic NSCLC Living Guideline - PubMed
6. 2022 ESC Guidelines on cardio-oncology, European Heart Journal
7. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)
8. Updated treatment recommendations for systemic treatment: from the ESMO non-oncogene-addicted metastatic NSCLC Living Guideline - PubMed
9. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS) | European Heart Journal | Oxford Academic
10. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)