Extremely Rapid Response to Pembrolizumab in a SMARCA4 Mutant PD-L1 Highly Expressive Advanced Lung Adenocarcinoma: A Case Report

Review Data

Q: Is the topic relevant to the journal area of interest? Is it contemporary and interesting for

researchers?

A: Good

Abstract & Keywords

Q: Are all required components included in the abstract? Are the keywords appropriately chosen?

A: Good

Goal

Q: Is the goal explicitly stated in the Introduction? Is its formulation clear and unambiguous?

A: Good

Structure

Q: Is the paper's structure coherent? Is it in coherence with the goal of the paper?

A: Very Good

Tools and Methods

Q: Are methods the author uses adequate and well used?

A: Good

Discussion & Conclusion

Q: Is it related to the results presented before? Do you consider them as coherent?

A: Good

Comments: The Discussion establishes that this is the first case report of a SMARCA4 mutant non-small cell lung cancer (SMARCA4m-NSCLC) patient showing high expression of programmed death-ligand1 (PD-L1) in the tumor. It highlights that this case report is of importance as it has shown PD-1 inhibitors may be effective for SMARCA4m-NSCLC. Relevant literature has been cited to support the Discussion. The study concludes that in the case of PD-L1 positive SMARCA4m-NSCLC immune checkpoint inhibitors (ICIs) may be a promising treatment option.

Literature

Q: Does the author utilize relevant literature?

A: Good

Author's knowledge

Q: What is the level of the author’s knowledge? Does the author utilize all recent contributions relevant to the topic?

A: Good

Length

Q: Is the length of the paper adequate to the significance of the topic? Do you suggest shortening the paper without losing its value?

A: Good

Figures & Tables

Q: Does the author use them suitably? Are legend and notations clear?

A: Good

Writing style

Q: Is it clear and understandable?

A: Good

Comments: Except the following errors have been detected:

1.     The 10^th sentence under Abstract was not framed properly and should be changed to “With only…. inhibited tumor growth and a partial response was obtained.”

2.     The 1^st sentence in the 2^nd paragraph under Introduction was not framed properly and should be changed to “Recently, a study reported that…. might improve OS.”

3.     The 2^nd sentence in the 3^rd paragraph under Case Report was not making sense and should be changed to “After 41 cycles of…. was tiny compared to pre-treatment, indicating that pembrolizumab was sustained effective.”

4.     The 1^st sentence in the 2^nd paragraph under Discussion was not framed properly and should be changed to “Recently, several reports showed that ICIs were effective and safe for … SMARCA4m-tumors.”

5.     In the 6^th sentence in the 3^rd paragraph under Discussion the word “response” has been misspelled.

Further comments on the paper

Comments: This first of its kind case report presents the case of a 67-year-old man with programmed death-ligand1 (PD-L1) highly expressive SMARCA4 mutant non-small cell lung cancer (SMARCA4m-NSCLC) who showed an extremely rapid and long-term response to pembrolizumab. The survival outcome of SMARCA4m-NSCLC patients is poor, thus making this case report important as it has shown that PD-1 inhibitors may be effective for SMARCA4m-NSCLC. The study highlights that in this case, with only one dose of pembrolizumab tumor growth was significantly inhibited. SMARCA4 and K-RAS co-mutations might have caused PD-L1 to increase. The study concludes that an extremely rapid and long-term response can be achieved with pembrolizumab for PD-L1 highly expressive SMARCA4m-NSCLC and immune checkpoint inhibitors treatment may be a promising strategy for PD-L1 positive SMARCA4m-NSCLC. Due to the absence of individual case reports, the efficacy of PD-1 inhibitor needs to be further investigated in a larger patient cohort with SMARCA4m-NSCLC.

Q: Would you recommend this manuscript for further publication?

A: Yes - Suitable to be published

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Science Repository Team