AME case reports · 2026
Induction of complete pathological response by immunochemotherapy in stage IIIA-N2 patients with SMARCA4-deficient lung adenocarcinoma: a case report.
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Chen Sheng, Dai Zunqiang, Li Jianfeng, Yu Jie, Wang Haiwen
Аннотация
BACKGROUND: SMARCA4-deficient lung adenocarcinoma (SMARCA4-dADC) is an aggressive and poorly differentiated subtype of non-small cell lung cancer (NSCLC), often lacking thyroid transcription factor-1 (TTF-1) expression and associated with poor prognosis. Optimal management for locally advanced SMARCA4-dADC remains unclear, as these tumors typically show limited response to conventional chemotherapy or immunotherapy. Reports of effective neoadjuvant strategies in this population are extremely rare.
CASE DESCRIPTION: We report a 65-year-old male smoker diagnosed with stage cT3N2M0 (IIIA) SMARCA4-dADC, confirmed by immunohistochemistry showing SMARCA4 loss and programmed death-ligand 1 (PD-L1) tumor proportion score <1%. The patient received neoadjuvant chemoimmunotherapy followed by right upper lobectomy with systematic lymphadenectomy. Post-treatment imaging demonstrated a partial response (PR), with tumor size decreasing from 66 mm × 53 mm to 31 mm × 28 mm and clinical downstaging to ycT2aN0M0 (stage IB). Pathological evaluation of the resected specimen revealed a complete response, with 0% viable tumor cells in both the primary tumor and lymph nodes. The treatment was well-tolerated without delays or surgical complications.
CONCLUSIONS: This case highlights the potential efficacy of neoadjuvant chemoimmunotherapy in achieving pathological complete response (pCR) in locally advanced SMARCA4-dADC, enabling tumor downstaging and curative resection. It represents one of the first reported instances of pCR in this rare NSCLC subtype and suggests that such an approach may provide a promising treatment option. Prospective studies are needed to validate these findings and guide clinical practice.
CASE DESCRIPTION: We report a 65-year-old male smoker diagnosed with stage cT3N2M0 (IIIA) SMARCA4-dADC, confirmed by immunohistochemistry showing SMARCA4 loss and programmed death-ligand 1 (PD-L1) tumor proportion score <1%. The patient received neoadjuvant chemoimmunotherapy followed by right upper lobectomy with systematic lymphadenectomy. Post-treatment imaging demonstrated a partial response (PR), with tumor size decreasing from 66 mm × 53 mm to 31 mm × 28 mm and clinical downstaging to ycT2aN0M0 (stage IB). Pathological evaluation of the resected specimen revealed a complete response, with 0% viable tumor cells in both the primary tumor and lymph nodes. The treatment was well-tolerated without delays or surgical complications.
CONCLUSIONS: This case highlights the potential efficacy of neoadjuvant chemoimmunotherapy in achieving pathological complete response (pCR) in locally advanced SMARCA4-dADC, enabling tumor downstaging and curative resection. It represents one of the first reported instances of pCR in this rare NSCLC subtype and suggests that such an approach may provide a promising treatment option. Prospective studies are needed to validate these findings and guide clinical practice.