2023 Volume 42 Issue 3 Pages 263-271
Synopsis: Lazarus-type response refers to drastic and significant improvement with immunotherapy in advanced cancer patients with poor general condition. We report a case of Lazarus-type response to pembrolizumab in endometrial cancer.
A 43-year-old nulliparous woman with no relevant past medical history was referred to our hospital due to hypermenorrhea and dysmenorrhea. Imaging analyses revealed a tumor of the corpus uteri extending to the cervix with metastases in the pelvic and paraaortic lymph nodes above the renal vein. Tumor biopsy revealed grade 3 endometrioid carcinoma, and a diagnosis of FIGO clinical stage IIIC2 was made.
The tumor progressed rapidly after four courses of carboplatin and paclitaxel chemotherapy. Radical hysterectomy and ileal conduit diversion were performed for tumor reduction. The residual tumor continued to progress during 2nd line chemotherapy, and she was classified as PS 4 because of uncontrollable cancer pain with opioid administration. As she wished to continue treatment, pembrolizumab was administered based on genetic analysis of the tumor indicating microsatellite instability-high.
The patient showed drastic improvement after three courses of pembrolizumab. After treatment with 20 cycles of pembrolizumab for 2 years, computed tomography and analyses of tumor markers indicated no tumor progression and she maintained PS 0.
