Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1609
Peer-review started: July 30, 2021
First decision: October 25, 2021
Revised: November 7, 2021
Accepted: January 6, 2022
Article in press: January 6, 2022
Published online: February 16, 2022
Processing time: 196 Days and 1.7 Hours
The prognosis of refractory extranodal natural killer/T-cell lymphoma (ENKTL) is poor. Recent data have indicated that immune checkpoint blockade with a programmed cell death protein-1 (PD-1) antibody in combination with administration of histone deacetylase inhibitors represents a potentially effective treatment strategy. Compared with PD-1 antibodies, programmed death-ligand 1 antibodies have fewer side effects. Here, we present a rare case of a patient with refractory metastatic ENKTL who achieved sustained remission of approximately 10 mo with minor adverse effects after combination therapy with atezolizumab, chidamide, and radiotherapy.
A 56-year-old woman underwent resection of a tumour in her left nasal cavity and was diagnosed with ENKTL (nasal type). Medical examination revealed tumours observed in the bilateral nasal mucosa, the subcutaneous soft tissue of the inner side of the left eye, the soft tissue of the nasopharynx, the bilateral tonsils, and the left preauricular, right hilar, bilateral neck lymph nodes and bone marrow. However, tomography/computed tomography showed increased metabolism of the bilateral nasal mucosa and subcutaneous soft tissue of the inner side of the left eye and newly increased metabolism of the left cervical lymph node after chemotherapy. Therefore, combination therapy with chidamide, atezolizumab, and radiotherapy was performed. Fortunately, the patient achieved a complete response following 10 mo of combination therapy.
The outcome in this case suggests that the combination of atezolizumab, chidamide, and radiotherapy is a promising regimen for treating refractory metastatic ENKTL following chemotherapy treatment failure.
Core Tip: extranodal natural killer/T-cell lymphoma (ENKTL) is a subtype of non-Hodgkin lymphoma with poor outcomes because ENKTL cells express high levels of P-glycoprotein that mediate tumour multidrug resistance. Furthermore, the standard treatment modality for chemotherapy-resistant ENKTL remains debated. We have experienced a patient with refractory metastatic ENKTL who was resistant to conventional DDGP chemotherapy. Following systemic therapy with atezolizumab and chidamide in combination with local radiotherapy, the patient achieved sustained remission of approximately 10 mo with minor adverse effects.