Case Report: Long-term survival in advanced PD-L1-high squamous cell lung cancer following severe immune-related cardiotoxicity

The introduction of immune checkpoint inhibitors (ICIs) has reshaped the therapeutic landscape of advanced non-small cell lung cancer. However, immune-related adverse events (irAEs), including rare cases of life-threatening cardiotoxicity, pose a significant challenge for subsequent therapy selection. Evidence on optimal post-ICI strategies, particularly in patients who have experienced severe irAEs, remains limited. Herein, we report the case of a 58-year-old male smoker with stage IVA squamous cell lung carcinoma (cT4N3M1a, PD-L1 TPS 60%, EGFR wild-type) who developed grade 3 immune-mediated myocarditis after receiving chemoimmunotherapy, leading to permanent ICI discontinuation. After improvement of the immune-related myocarditis, the patient was administered second- and third-line treatment. The patient achieved a progression-free survival of 31 months following third-line treatment, with an overall survival of 43 months. This case demonstrated successful reversal of severe immune-related cardiac toxicity in a patient with advanced squamous cell lung cancer with high PD-L1 expression through personalized, precise, and multidisciplinary team diagnosis and treatment, achieving prolonged overall survival. Furthermore, this case suggested that anti-angiogenic therapy (anlotinib) can be safely administered as subsequent treatment for lung squamous cell carcinoma following recovery from severe immune-related cardiotoxicity.