Complete pathological response after primary tumor surgery following chemoimmunotherapy and stereotactic radiosurgery of initially metastatic non-small-cell lung cancer

Introduction Surgery of the primary tumor following extended course of chemoimmunotherapy has only recently been recognized as a feasible and safe option for selected groups of patients with initially unresectable non-small cell lung cancer. Case outline Here we report a case of a 49-year-old never smoking female patient that was diagnosed with metastatic non-small cell lung cancer. Lesions were evident in both lungs and the brain. She underwent stereotactic radiosurgery for brain metastases and combination therapy of chemotherapy, atezolizumab and bevacizumab. Response to therapy was both remarkable and durable. Ten cycles into treatment MRI of the brain revealed no metastatic lesions. PET/CT revealed a single lesion in the right upper lobe 22x23mm in diameter. The patient underwent a right upper lobectomy. Patohistological evaluation of the specimen revealed complete pathologic response. The patient recovered from surgery and continued chemoimmunotherapy. For four months post-surgery she is disease free and of excellent performance status. Conclusion Primary tumor surgery following extensive chemoimmunotherapy regiment is feasible and could be considered as a treatment option. Further research is warranted to define a patient population that stands to benefit the most from this modality.