A case of advanced lung cancer treated by surgery followed by adjuvant combination therapy of gefitinib and interleukin-2 lymphokine-activated killer cell immunotherapy

A smoker, 55-year-old male with a small nodule in left S5 on computed tomographic (CT) scanning of chest was diagnosed with pulmonary adenocarcinoma (cT1N0M0, c-stage IA). However, the CT scanning revealed that several small nodules on pleural surface might suspect a pleural dissemination, that is, IV-staged advanced lung cancer. The patient desired for receiving an aggressive multimodality containing of surgery, immunotherapy, and gefitinib treatment. After thoracotomy, the small pleural nodules were intraoperatively diagnosed with pleural dissemination by pathological examination. However, there was no malignant pleural effusion and intraoperative cytological examination of intrathoracic lavage resulted in a negative finding. Because of clinical N2-negative disease without malignant pleural effusion, left upper lobectomy with mediastinal lymph nodes dissection was preceded. The postoperative pathological examination disclosed pulmonary adnocarcinoma with mixed subtypes (pT1N2M1a, p-stage IV) and with micropapillary pattern. A detection test of epidermal growth factor receptor (EGFR) gene mutation revealed a positive result (L858R). As a systemic therapy, a combination chemotherapy of gemcitabine and carboplatin was performed in 2 cycles for the remained pleural dissemination. The patient received combination therapy of gefitinib and interleukin-2 lymphokine-activated killer cell immunotherapy in 6 cycles. A CT scanning of chest displayed disappearances of the remained pleural dissemination. There had been uneventful for 25 months. On the third postoperative year, a stereotactic radiotherapy surgery was performed for small three brain metastases. He had been healthy and received the gefitinib treatment for 45 months without any regrowing of the irradiated cerebral metastases and the treated pleural dissemination. The combination therapy of gefitinib and immunotherapy in the postoperative early phase would take advantage of extending the patient's progression-free survival, and also in case of the selected population of the advanced lung cancer harboring a EGFR mutation-positive.