The majority of patients with lung cancer are in the late stage (stages IIIB or IV) when diagnosed. However, clinical features, treatment and prognosis of some patients in stage IIIB are somewhat different from those in stage IV. Several clinical trials of neoadjuvant immunotherapy are changing the treatment strategy for patients with stage IB-IIIA non-small cell lung cancer (NSCLC). It remains unclear whether patients with stage IIIB NSCLC could benefit from neoadjuvant immunotherapy because they are often excluded from clinical trials. The IMpower150 trial showed promising results in the clinics of atezolizumab plus bevacizumab plus chemotherapy in patients with epidermal growth factor receptor (EGFR) mutation positive NSCLC. However, reports of this treatment strategy on EGFR exon 20 mutations are still lacking. Osimertinib is effective for T790M mutation but results of targeted therapy in other EGFR exon 20 mutations are not favorable and there is currently no effective long-term therapy. Patients harboring EGFR exon 20 G779F mutation have not been reported to achieve a complete response (CR). Here, we report the case of a 55-year-old man who was diagnosed as stage IIIB (cT1bN3M0) pulmonary adenocarcinoma by supraclavicular lymph node biopsy. He was administered chemotherapy plus durvalumab before surgery. The disease was considered as a partial response (PR), and the postoperative pathology revealed that a pathologic CR had been achieved. At the time of writing, no signs of recurrence had been observed in the preceding 15 months. Our case provides a new treatment option for such patients.
Keywords: Lung cancer; N3 lymph node metastasis; case report; neoadjuvant immunotherapy; uncommon epidermal growth factor receptor mutation (uncommon EGFR mutation).