Clinical challenge following the first cycle of immunotherapy

Introduction: We present the case of a 75-year-old man with good functional status and no geriatric syndromes, diagnosed in April 2023 with metastatic lung adenocarcinoma in the left lower lobe (bone metastasis in T10 and left adrenal gland), with 50% PD-L1 expression and no actionable driver gene alterations. Case report: First-line treatment with immunotherapy monotherapy was initiated. After the first cycle, the patient experienced clinical deterioration in the context of tumor hyperprogression (hepatic, nodal, bone, and pulmonary involvement) induced by immunotherapy. In response to this, a second-line regimen combining chemotherapy and immunotherapy was initiated, achieving clinical improvement and partial radiological response, with a progression-free survival of 18 months. Conclusion: During this second-line treatment and while on maintenance therapy, a local strategy involving radiotherapy was required to manage a solitary progression in the primary tumor and regional lymph nodes. This allowed continuation of maintenance therapy until November 2024. At that time, due to disease progression, a third-line chemotherapy regimen was initiated, which the patient continues to receive with stable disease to date.