A case of squamous cell lung carcinoma with bone metastasis responding to denosumab after zoledronic acid hydrate

Abstract

Background. Bone metastasis results from lung cancer at a frequency of 40% during the clinical course. Palliative radiotherapy and the administration of zoledronic acid hydrate are current bone lesion-targeted therapies. However, they are sometimes ineffective. Case. A 69-year-old man complaining of back pain was referred to our department due to an abnormal shadow on chest X-ray taken at an orthopedic surgery clinic. Computed tomography (CT) of the chest revealed a 55-mm mass with necrotic change in the left lower lobe, and magnetic resonance imaging (MRI) of the spine showed an eighth thoracic vertebral fracture. After bronchoscopy, the lung mass was diagnosed as a squamous cell carcinoma originating in the left S8/9 (cT2bN3M1b, stage IV). Pneumonia developed after bronchoscopy, therefore palliative radiotherapy and administration of zoledronic acid hydrate were initially done. As a first line chemotherapy, carboplatin and paclitaxel were effective for the primary lesion but ineffective for bone metastasis. Performance status (PS) worsened to 4 and chemotherapy was postponed after 2 courses. As a bone lesion-targeted therapy, zoledronic acid hydrate was changed to denosumab. One week after administration of denosumab, his back pain was reduced remarkably, and after 2 weeks of administration of denosumab, the patient became mobile. Biochemical markers of bone tumors, and MRI finding also improved after administration of denosumab. Second line chemotherapy was started with an improvement to 2 for PS, and administration of denosumab was also continued. Conclusions. Denosumab seemed effective in this patient and might have potential as a therapeutic alternative for bone metastasis if zoledronic acid hydrate administration is ineffective. © 2012 The Japan Lung Cancer Society.