Case Report: Neoadjuvant chemoimmunotherapy achieving pathological complete response in two cases of stage III EGFR-mutant NSCLC with high PD-L1 expression. (PubMed, Front Oncol)
Case 1, a 60-year-old male harboring an EGFR exon 19 deletion, received three cycles of pemetrexed, carboplatin, and pembrolizumab, followed by R0 resection; postoperative adjuvant pembrolizumab was discontinued after one cycle because of grade 2 dizziness (CTCAE v5.0). Case 2, a 52-year-old female with an EGFR exon 21 L861Q missense mutation co-occurring with TP53 and PIK3CA alterations, exhibited primary resistance to afatinib with radiographic progression after one month. She subsequently underwent three cycles of pemetrexed, carboplatin, and sintilimab, achieving R0 resection with pCR, and declined further postoperative therapy...These cases suggest that for a specific subset of EGFR-mutant NSCLC-particularly those with high PD-L1 expression and in whom targeted therapy has failed-neoadjuvant chemoimmunotherapy may serve as a potent individualized strategy capable of overcoming pre-existing immune tolerance and inducing profound pathological responses. Nevertheless, this evidence remains strictly anecdotal; validation through large-scale, prospective, biomarker-driven clinical trials is imperative before any modification of standard clinical practice.