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Peer-reviewedCC BYFrontiers in oncology

Case Report: Low-dose radiotherapy as part of multimodal salvage therapy for immunotherapy-resistant SMARCA4-deficient non-small cell lung cancer.

  • Tong Bu1,2
  • Nan Zhang1,2
  • Tong Jin1,2
  • Zixuan Wang1,2
  • Yichen Mao1,2
  • Dan Zong1,2
  • Wenjie Guo1,2
  • Xia He1,2
  1. 1Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China.
  2. 2Jiangsu Key Laboratory of Innovative Cancer Diagnosis & Therapeutics, Nanjing, China.
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Abstract

SMARCA4-deficient non-small cell lung cancer (SD-NSCLC) is a highly aggressive molecular subtype. This malignancy is often diagnosed at an advanced stage, carrying a dismal prognosis and also demonstrating poor responsiveness to traditional treatment. Beyond its primary site, the disease can exhibit unusual metastatic patterns such as metastasis to oral soft tissues. We report a unique case of a 61-year-old male heavy smoker with molecularly confirmed SD-NSCLC who experienced rapid metastatic progression to the right gingiva and neck lymph nodes shortly after radical surgery and initial chemo-immunotherapy. This clinical scenario exemplifies primary resistance to immune checkpoint inhibitors (ICIs), where pre-existing genetic or microenvironmental barriers hinder initial therapeutic success. To overcome this resistance, a salvage multimodal strategy was implemented, integrating ICIs with etoposide/cisplatin (EP) chemotherapy and low-dose radiotherapy (LDRT). Remarkably, this regimen achieved significant regression of the bulky metastatic lesions and has maintained sustained disease stability for over 15 months, with the patient remaining clinically stable as of the latest follow-up in June 2026. This case may hint the potential role of LDRT as an immunomodulatory component to overcome primary resistance in SD-NSCLC, suggesting a potential therapeutic strategy for patients who experience disease progression following first-line chemo-immunotherapy.

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Cite

BibTeXRIS
BibTeX
@article{bu2026case,
  title = {{Case Report: Low-dose radiotherapy as part of multimodal salvage therapy for immunotherapy-resistant SMARCA4-deficient non-small cell lung cancer.}},
  author = {Tong Bu and Nan Zhang and Tong Jin and Zixuan Wang and Yichen Mao and Dan Zong and Wenjie Guo and Xia He},
  journal = {Frontiers in oncology},
  year = {2026},
  month = oct,
  doi = {10.3389/fonc.2026.1941008},
  url = {https://europepmc.org/article/MED/42898113},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Case Report: Low-dose radiotherapy as part of multimodal salvage therapy for immunotherapy-resistant SMARCA4-deficient non-small cell lung cancer.
AU  - Tong Bu
AU  - Nan Zhang
AU  - Tong Jin
AU  - Zixuan Wang
AU  - Yichen Mao
AU  - Dan Zong
AU  - Wenjie Guo
AU  - Xia He
PY  - 2026
DA  - 2026/10/05
JO  - Frontiers in oncology
DO  - 10.3389/fonc.2026.1941008
UR  - https://europepmc.org/article/MED/42898113
AB  - SMARCA4-deficient non-small cell lung cancer (SD-NSCLC) is a highly aggressive molecular subtype. This malignancy is often diagnosed at an advanced stage, carrying a dismal prognosis and also demonstrating poor responsiveness to traditional treatment. Beyond its primary site, the disease can exhibit unusual metastatic patterns such as metastasis to oral soft tissues. We report a unique case of a 61-year-old male heavy smoker with molecularly confirmed SD-NSCLC who experienced rapid metastatic progression to the right gingiva and neck lymph nodes shortly after radical surgery and initial chemo-immunotherapy. This clinical scenario exemplifies primary resistance to immune checkpoint inhibitors (ICIs), where pre-existing genetic or microenvironmental barriers hinder initial therapeutic success. To overcome this resistance, a salvage multimodal strategy was implemented, integrating ICIs with etoposide/cisplatin (EP) chemotherapy and low-dose radiotherapy (LDRT). Remarkably, this regimen achieved significant regression of the bulky metastatic lesions and has maintained sustained disease stability for over 15 months, with the patient remaining clinically stable as of the latest follow-up in June 2026. This case may hint the potential role of LDRT as an immunomodulatory component to overcome primary resistance in SD-NSCLC, suggesting a potential therapeutic strategy for patients who experience disease progression following first-line chemo-immunotherapy.
SN  - 2234-943X
ER  -