Vol 20, No 2 (2024)
Case report
Published online: 2023-10-27

open access

Page views 318
Article views/downloads 232
Get Citation

Connect on Social Media

Connect on Social Media

Immunochemotherapy in a 25-year-old male patient with small-cell lung cancer

Aleksandra Łomża1, Bernadeta Maliszewska1, Łukasz Łaba1, Izabela Chmielewska2, Iwona Paśnik3, Renata Langfort4, Michał Gil2, Krawczyk Paweł2
Oncol Clin Pract 2024;20(2):152-159.


Lung cancer is the leading cause of cancer-related deaths, both in males and females. Small-cell lung cancer (SCLC) is a strongly tobacco-dependent type of lung cancer characterized by aggressiveness, rapid growth, and a high tendency to metastasize. SCLC is the most commonly diagnosed in an advanced — metastatic — stage in patients with many comorbidities and inadequate performance status. However, based on the most current recommendations, chemotherapy in combination with immunotherapy at the extensive stage (ES) of SCLC, significantly improves the therapeutic efficiency. Here, we present a case of a 25-year-old man, diagnosed with SCLC, with a medical history of 10 years of smoking e-cigarettes and marijuana as well as the use of amphetamine and alcohol. In the diagnosis process, considering the young age of the patient, the next-generation sequencing (NGS) was performed, but no molecular alterations in oncogenes were found. During the immunochemotherapy with atezolizumab, carboplatin, and etoposide, immune-related adverse events (irAEs), in the form of hepatotoxicity, were observed. After the toxicity subsided, the immunotherapy was continued with a very good effect and tolerance. The patient has remained in partial remission for 9 months. The presented case highlights the possibility of treatment continuation despite mild adverse events triggered by immunotherapy and the need for more research in the group of young patients diagnosed with SCLC.

Article available in PDF format

View PDF Download PDF file


  1. Torre LA, Siegel RL, Ward EM, et al. Global Cancer Incidence and Mortality Rates and Trends--An Update. Cancer Epidemiol Biomarkers Prev. 2016; 25(1): 16–27.
  2. Kalemkerian GP. Staging and imaging of small cell lung cancer. Cancer Imaging. 2012; 11(1): 253–258.
  3. Gazdar AF, Bunn PA, Minna JD. Small-cell lung cancer: what we know, what we need to know and the path forward. Nat Rev Cancer. 2017; 17(12): 725–737.
  4. Byers LA, Rudin CM. Small cell lung cancer: where do we go from here? Cancer. 2015; 121(5): 664–672.
  5. Memmott RM, Wolfe AR, Carbone DP, et al. Predictors of Response, Progression-Free Survival, and Overall Survival in Patients With Lung Cancer Treated With Immune Checkpoint Inhibitors. J Thorac Oncol. 2021; 16(7): 1086–1098.
  6. Wang Y, Zou S, Zhao Z, et al. New insights into small-cell lung cancer development and therapy. Cell Biol Int. 2020; 44(8): 1564–1576.
  7. Slotman B, Faivre-Finn C, Kramer G, et al. EORTC Radiation Oncology Group and Lung Cancer Group. Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med. 2007; 357(7): 664–672.
  8. Hou J, Li H, Ma S, et al. Emerging therapies for small cell lung cancer. J Hematol Oncol. 2019; 12(1): 47.
  9. El Sayed R, Blais N. Immunotherapy in Extensive-Stage Small Cell Lung Cancer. Curr Oncol. 2021; 28(5): 4093–4108.
  10. Liu SV, Reck M, Mansfield AS, et al. Updated Overall Survival and PD-L1 Subgroup Analysis of Patients With Extensive-Stage Small-Cell Lung Cancer Treated With Atezolizumab, Carboplatin, and Etoposide (IMpower133). J Clin Oncol. 2021; 39(6): 619–630.
  11. Horn L, Mansfield AS, Szczęsna A, et al. IMpower133 Study Group. First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer. N Engl J Med. 2018; 379(23): 2220–2229.
  12. Liu X, Xing H, Liu B. Current status and future perspectives of immune checkpoint inhibitors in extensive-stage small cell lung cancer. Am J Cancer Res. 2022; 12(6): 2447–2464.
  13. Lin S, Luo S, Gu D, et al. First-Line Durvalumab in Addition to Etoposide and Platinum for Extensive-Stage Small Cell Lung Cancer: A U.S.-Based Cost-Effectiveness Analysis. Oncologist. 2021; 26(11): e2013–e2020.
  14. Paz-Ares L, Dvorkin M, Chen Y, et al. CASPIAN investigators. Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet. 2019; 394(10212): 1929–1939.
  15. Autio KA, Boni V, Humphrey RW, et al. Probody Therapeutics: An Emerging Class of Therapies Designed to Enhance On-Target Effects with Reduced Off-Tumor Toxicity for Use in Immuno-Oncology. Clin Cancer Res. 2020; 26(5): 984–989.
  16. Da Cunha T, Wu GY, Vaziri H. Immunotherapy-induced Hepatotoxicity: A Review. J Clin Transl Hepatol. 2022; 10(6): 1194–1204.
  17. Swanson LA, Kassab I, Tsung I, et al. Liver injury during durvalumab-based immunotherapy is associated with poorer patient survival: A retrospective analysis. Front Oncol. 2022; 12: 984940.
  18. Haanen J, Obeid M, Spain L, et al. ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022; 33(12): 1217–1238.
  19. Arnold BN, Thomas DC, Rosen JE, et al. Lung Cancer in the Very Young: Treatment and Survival in the National Cancer Data Base. J Thorac Oncol. 2016; 11(7): 1121–1131.
  20. Lee MH, Qureshi MM, Suzuki K, et al. Small cell lung cancer in young patients: trends in sociodemographic factors, diagnosis, treatment, and survival. J Thorac Dis. 2022; 14(8): 2880–2893.
  21. Kothadia JP, Chhabra S, Marcus A, et al. Anterior mediastinal mass in a young marijuana smoker: a rare case of small-cell lung cancer. Case Rep Med. 2012; 2012: 754231.
  22. Herman M, Tarran R. E-cigarettes, nicotine, the lung and the brain: multi-level cascading pathophysiology. J Physiol. 2020; 598(22): 5063–5071.
  23. Cummings KM, Dresler CM, Field JK, et al. E-cigarettes and cancer patients. J Thorac Oncol. 2014; 9(4): 438–441.
  24. Gotts JE, Jordt SE, McConnell R, et al. What are the respiratory effects of e-cigarettes? BMJ. 2019; 366: l5275.
  25. Bracken-Clarke D, Kapoor D, Baird AM, et al. Vaping and lung cancer - A review of current data and recommendations. Lung Cancer. 2021; 153: 11–20.
  26. Schaal CM, Bora-Singhal N, Kumar DM, et al. Regulation of Sox2 and stemness by nicotine and electronic-cigarettes in non-small cell lung cancer. Mol Cancer. 2018; 17(1): 149.
  27. Kalininskiy A, Bach CT, Nacca NE, et al. E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach. Lancet Respir Med. 2019; 7(12): 1017–1026.
  28. Rice SJ, Hyland V, Behera M, et al. Guidance on the Clinical Management of Electronic Cigarette or Vaping-Associated Lung Injury. J Thorac Oncol. 2020; 15(11): 1727–1737.