Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2022; 10(5): 1609-1616
Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1609
Combination of atezolizumab and chidamide to maintain long-term remission in refractory metastatic extranodal natural killer/T-cell lymphoma: A case report
Juan Wang, Yong-Sheng Gao, Kun Xu, Xiao-Dong Li
Juan Wang, Xiao-Dong Li, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, China
Yong-Sheng Gao, Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, China
Kun Xu, Department of Gastrointestinal Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, China
Author contributions: Li XD designed the research study; Wang J collected data of the study; Gao YS advised on the pathological report; and Xu K wrote the manuscript; all authors have read and approve the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Dong Li, MD, PhD, Doctor, Professor, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan 250117, Shandong Province, China. sylxd1306@163.com
Received: July 30, 2021
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Long-term remission; Refractory metastatic extranodal natural killer/T-cell lymphoma; Histone deacetylase; Programmed death-ligand 1 antibody; Radiotherapy; Case report

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.