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Carcinoma de pulmón de célula pequeña: reporte de un caso con respuesta clínica completa al tratamiento con quimioinmunoterapia
Small cell lung cancer: case report with complete clinical response to chemoimmunotherapy
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Osma Charris HR, González Hurtado D, Alzate S, Lasso Carlosama M. Carcinoma de pulmón de célula pequeña: reporte de un caso con respuesta clínica completa al tratamiento con quimioinmunoterapia. Rev. colomb. hematol. oncol. [Internet]. 2025 Jun. 27 [cited 2025 Dec. 5];12(1):163-74. https://doi.org/10.51643/22562915.709
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Osma Charris HR, González Hurtado D, Alzate S, Lasso Carlosama M. Carcinoma de pulmón de célula pequeña: reporte de un caso con respuesta clínica completa al tratamiento con quimioinmunoterapia. Rev. colomb. hematol. oncol. [Internet]. 2025 Jun. 27 [cited 2025 Dec. 5];12(1):163-74. https://doi.org/10.51643/22562915.709
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Introducción: el carcinoma de pulmón de célula pequeña (CPCP) corresponde al 15 % de los casos de cáncer de pulmón. Se clasifica como enfermedad extendida (CPCP-EE) si hay metástasis o si el volumen de enfermedad no puede ser abarcado en un campo único de radioterapia. Dos tercios de los casos debutan con enfermedad extendida y por ende con pobre pronóstico. A pesar de lograr altas tasas de respuesta objetiva (TRO) al tratamiento, las tasas de respuesta completa (RC) no superan el 3 % y la gran mayoría de pacientes recae tempranamente. Actualmente el bloqueo del eje PD-1 en combinación con quimioterapia a base de platinos es el estándar de cuidado. Caso clínico: paciente de 57 años con CPCP-EE que tras cuatro ciclos con quimioinmunoterapia con durvalumab y carboplatino+etopósido logra RC, la cual mantiene luego veintidós meses de tratamiento. Conclusión: se ha encontrado relación entre la TRO y la supervivencia, pero se desconoce si la RC puede ser un subrogado de supervivencia global en CPCP en la era de la inmunoterapia. En este caso, la ausencia de factores de mal pronóstico como la enfermedad metastásica extratorácica, probablemente haya favorecido la RC. Biomarcadores como PD-L1 y TMB al día de hoy no permiten seleccionar el tratamiento. En estudios de transcriptómica el subtipo inflamado (CPCP-I) parece tener un mayor beneficio derivado de la inmunoterapia, sin embargo, se requieren estudios de validación prospectiva
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