Consolidation immunotherapy after concurrent chemoradiotherapy enabling conversion surgery for stage IIIB pulmonary NUT carcinoma: a case report and literature review

Background Pulmonary NUT carcinoma is a rare, highly aggressive malignancy. Its clinical presentation is nonspecific, so most patients are diagnosed at an advanced stage and face a very poor prognosis. At present, no standard treatment regimen has been established. Case presentation We report a 45-year-old man diagnosed with stage cT4N2M0 (IIIB) pulmonary NUT carcinoma. He received induction chemotherapy with etoposide plus cisplatin (EP regimen) combined with atezolizumab, followed by concurrent chemoradiotherapy (with immunotherapy withheld during radiotherapy), then consolidative chemoimmunotherapy and surgery. Postoperative pathology demonstrated a pathological complete response (pCR), and the patient has remained alive for more than 49 months since diagnosis with good treatment tolerance. Literature review and discussion We performed a pooled analysis of 72 cases of pulmonary NUT carcinoma reported since 2015. The median overall survival (OS) was 5.6 months. Patients who underwent surgical treatment had improved survival compared with those who did not. Immunotherapy was associated with significantly improved OS. Conclusion In carefully selected patients with locally advanced pulmonary NUT carcinoma, individualized multimodality treatment can achieve a pCR and prolonged survival, underscoring the importance of accurate molecular diagnosis, early multidisciplinary management, and reassessment of surgical resectability. Nevertheless, this treatment sequence remains hypothesis-generating and requires validation in prospective studies.