Combination of immunotherapy, radiotherapy and denosumab as the best approach even for NSCLC poor prognosis patients: a case report with strong response, prolonged survival and a review of literature.

Non-Small Cell Lung Cancer (NSCLC) with bone metastasis and poor performance status has the worst prognosis even in strong PD-L1 expression patients. Treatment approach includes immuno- or chemo-immunotherapy, Radiotherapy (RT) and Bone-Targeted Therapy (BTT) but there is insufficient data to suggest the best time to use each of them, alone or in combination. Using an integrated and synergistic treatment strategy with immunotherapy, radiotherapy, and Denosumab as BTT is probably the best treatment planning for metastatic NSCLC for both good and poor performance status patients, although more data are needed to confirm this approach. Here we describe an interesting case report on patient with extensive bone involvement from NSCLC and PS >2 treated simultaneously with radiotherapy, immunotherapy and BTT, achieving an excellent clinical benefit, radiological and metabolic complete response, as a sort of Lazarus effect. We analyzed our result comparing with currently published data about radio-immunotherapy or immunotherapy and BTT combination even though there is no published experience about integration of all 3 treatments. Approval studies often do not represent real-world experience (RWE), so we analyzed data from both RWE and clinical trials.

Eribulin as a Feasible and Safe Monotherapy in a Dialytic Pretreated Woman with Metastatic Breast Cancer: A Case Report.

Eribulin, a non-taxane inhibitor of microtubule dynamics, is approved for the treatment of metastatic breast cancer patients after progression with anthracyclines and taxanes. Nevertheless, to our knowledge, information on its use in dialytic patients is not available to date. This report describes the case of a chemo-pretreated dialytic woman with lung, bone, and liver metastasis from breast cancer, who experienced stable disease with a response < 20% with eribulin in fifth line after 3 hormonal lines and 1 chemotherapy line. This case suggests the feasibility and good tolerability of eribulin in this peculiar setting.