Coeliac lymph nodes SBRT Combined with Immunotherapy Rechallenge Induce Abscopal Effect in Metastatic Non-Small-Cell Lung Cancer: A Case Report and Literature Review

Abstract

Stereotactic body radiotherapy (SBRT) may enhance synergistic effects of immunotherapies and radiotherapy (iRT), with the potential to induce abscopal effect in irradiated and non-irradiated sites. The case of a metastatic non-small-cell lung cancer (NSCLC) male patient with acquired immune checkpoint inhibitor (ICI) resistance (third-line setting) is reported.  He received coeliac lymph node SBRT plus ICI re-challenge. This regimen induced abscopal effect on the patient’s metastatic liver lesions. Despite negative PD-L1 expression and low tumour mutation burden (TMB) in liver biopsies, the patient achieved a progression-free survival (PFS) exceeding 12 months post-rechallenge, with 29 months of overall survival (OS) from initial ICI treatment (the follow-up ended in October 2021 due to the patient’s death). Reports on draining lymph node (DLN) SBRT combined with ICI re-challenge in immunotherapy-resistant metastatic NSCLC remain scarce, especially when targeting coeliac lymph nodes. This case suggests that DLN SBRT plus ICIs could be a reasonable option for such immunotherapy-resistant patients.

Keywords: Non-small-cell lung cancer; Immune checkpoint inhibitor; Stereotactic Body Radiotherapy; Abscopal effect; Draining lymph node; Rechallenge.