ArticleAME case reports2026
Induction of complete pathological response by immunochemotherapy in stage IIIA-N2 patients with SMARCA4-deficient lung adenocarcinoma: a case report.
Article in AME case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: SMARCA4-deficient lung adenocarcinoma (SMARCA4-dADC) is an aggressive and poorly differentiated subtype of non-small cell lung cancer (NSCLC), often lacking thyroid transcription factor-1 (TTF-1) expression and associated with poor prognosis. Optimal management for locally advanced SMARCA4-dADC remains unclear, as these tumors typically show limited response to conventional chemotherapy or immunotherapy. Reports of effective neoadjuvant strategies in this population are extremely rare. Case Description: We report a 65-year-old male smoker diagnosed with stage cT3N2M0 (IIIA) SMARCA4-dADC, confirmed by immunohistochemistry showing SMARCA4 loss and programmed death-ligand 1 (PD-L1) tumor proportion score <1%. The patient received neoadjuvant chemoimmunotherapy followed by right upper lobectomy with systematic lymphadenectomy. Post-treatment imaging demonstrated a partial response (PR), with tumor size decreasing from 66 mm × 53 mm to 31 mm × 28 mm and clinical downstaging to ycT2aN0M0 (stage IB). Pathological evaluation of the resected specimen revealed a complete response, with 0% viable tumor cells in both the primary tumor and lymph nodes. The treatment was well-tolerated without delays or surgical complications. Conclusions: This case highlights the potential efficacy of neoadjuvant chemoimmunotherapy in achieving pathological complete response (pCR) in locally advanced SMARCA4-dADC, enabling tumor downstaging and curative resection. It represents one of the first reported instances of pCR in this rare NSCLC subtype and suggests that such an approach may provide a promising treatment option. Prospective studies are needed to validate these findings and guide clinical practice.
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