---
title: "Sintilimab Plus ADT for Synchronous Prostate Adenocarcinoma and Lung Squamous Cell Carcinoma in a"
id: "frontiers-in-immunology-7-successful-management-of-synchronous-prostate-adenocarcinoma-and-lung-squamous"
canonical_url: "https://medichelpline.com/clinical-feed/frontiers-in-immunology-7-successful-management-of-synchronous-prostate-adenocarcinoma-and-lung-squamous"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "Frontiers in Immunology"
source_url: "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1845049"
published_at: "2026-10-01T00:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Sintilimab Plus ADT for Synchronous Prostate Adenocarcinoma and Lung Squamous Cell Carcinoma in a
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/frontiers-in-immunology-7-successful-management-of-synchronous-prostate-adenocarcinoma-and-lung-squamous
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** Frontiers in Immunology
- **Source URL:** [Original Journal Publication](https://www.frontiersin.org/articles/10.3389/fimmu.2026.1845049)
- **Published At:** 2026-10-01T00:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This source is a CASE REPORT describing the management of a single frail elderly patient who had synchronous **prostate adenocarcinoma** and **lung squamous cell carcinoma** and comorbid **bronchiectasis**. - The patient was treated with a combination of **sintilimab** (an immune checkpoint inhibitor) and **androgen deprivation therapy (ADT)**. - The article title indicates the management was described as successful, but the body of the provided source text did not include clinical details, metrics, timelines, imaging, pathology, dosing, response assessments, adverse events, or follow-up data. - The source material available here contains only site navigation and header content from the journal and does not include the case narrative, methods, results, or discussion sections of the report. - Because the source text did not report the case details, specifics such as patient age, baseline performance status, bronchiectasis severity, diagnostic confirmation for both cancers, rationale for combining **sintilimab** with **ADT**, monitoring strategy, infectious prophylaxis, or the exact meaning of “successful management” are not available from this document. - The lack of reported details prevents extraction of outcome measures, safety data, or generalizable recommendations from the source provided. - Readers should consult the full published article for complete clinical data, diagnostic criteria, treatment protocol, outcomes, and authors’ discussion and conclusions; those elements were not present in the supplied source content.
## Clinical Analysis & Structured Key Points
Frontiers | Successful management of synchronous prostate adenocarcinoma and lung squamous cell carcinoma with sintilimab and ADT in a frail elderly patient with bronchiectasis: a case report CASE REPORT article Front. Immunol. , 01 October 2026 Sec. Cancer Immunity and Immunotherapy Volume 17 - 2026 | https://doi.org/10.3389/fimmu.2026.1845049 Published in Frontiers in Immunology Cancer Immunity and Immunotherapy 7 impact factor 11.3 citescore Part of a Research Topic Personalized Immuno-Oncology: The Impact of Age and Sex on Anti-Tumor Immune Responses 32k views 14 articles Editor & Reviewers Edited by L W Lisa Weissmann (née Deloch) Reviewed by T B Tareg Bey A B Ahmad Basharat Outline Figures and Tables Figure 1 View in article Figure 2 View in article Figure 3 View in article Figure 4 View in article Table 1 Timeline of the patient’s whole treatment and follow-up process. View in article Table 2 Systematic irAE grading by organ system (CTCAE v5.0) during full-dose sintilimab therapy. View in article CASE REPORT article Front. Immunol. , 01 October 2026 Sec. Cancer Immunity and Immunotherapy Volume 17 - 2026 | https://doi.org/10.3389/fimmu.2026.1845049 Successful management of synchronous prostate adenocarcinoma and lung squamous cell carcinoma with sintilimab and ADT in a frail elderly patient with bronchiectasis: a case report Y H Yuerong Huang W Z Wanlin Zhan T S Tingfeng Su Y L Ying Liu * Department of Oncology, People’s Hospital of Huadu District, Guangzhou, Guangdong, China Article metrics View details Abstract Background: The management of elderly patients with multiple primary malignant neoplasms (MPMNs) presents a significant clinical challenge, requiring a balance between oncological efficacy and treatment tolerability. This case report details an elderly, non-verbal male with significant cardiopulmonary comorbidities who presented with synchronous prostate adenocarcinoma and lung squamous cell carcinoma (LUSC). The coexistence of two primary malignancies complicated by recurrent pulmonary infection is exceedingly rare in both clinical guidelines and real-world practice, making the proposed treatment strategy particularly valuable for clinical reference. Case presentation: A 74-year-old congenitally deaf-mute male with high frailty risk, complicated by hypertension, coronary heart disease and bronchiectasis with chronic Pseudomonas aeruginosa colonization, was diagnosed with synchronous prostate adenocarcinoma and lung squamous cell carcinoma (LUSC). In the available archival pathology report, immunohistochemical testing used a PD-1 mouse monoclonal antibody (clone MX033; Fuzhou Maixin Biotechnology Co., Ltd.) and showed PD-1 positivity in no more than 1% of infiltrating lymphocytes. This result does not measure PD-L1 expression on tumor cells and does not provide a tumor proportion score (TPS); the original 2024 slides were archived and no tumor-cell PD-L1 assay/TPS result was available for re-evaluation. Baseline comprehensive geriatric assessment (CGA) confirmed high chemotherapy toxicity risk, and the patient’s family declined platinum-doublet intensive chemotherapy. Initial combined androgen deprivation therapy (ADT) for prostate cancer plus afatinib first-line targeted therapy for LUSC failed to control the disease, followed by progressive disease after second-line single-agent vinorelbine. Subsequently, standard-dose sintilimab (PD-1 inhibitor) monotherapy was administered as third-line treatment for LUSC with continuous ADT maintained for prostate cancer. Results: Serial radiology revealed durable marked regression of lung lesions and sustained stable prostate disease, achieving synchronous dual-tumor control. Sintilimab was prescribed on a q21-day schedule but was not delivered uninterruptedly: 12 administrations were given between December 24, 2024 and June 9, 2026, with infection-related interruptions, including a longest interval of more than 3 months. Recurrent bronchiectasis exacerbations with Pseudomonas aeruginosa infection were managed by culture-directed antibiotics and temporary interruption rather than permanent cessation of immunotherapy. No grade 2 or higher immune-related adverse events were documented during the reported follow-up, and the patient’s clinical condition and tumor status were stable at the latest recorded follow-up. Conclusion: This single case describes the clinical feasibility of standard-dose sintilimab plus ongoing ADT for synchronous prostate adenocarcinoma and LUSC in a frail elderly patient who declined platinum-doublet intensive chemotherapy. The observed response occurred in the context of intermittent, infection-related treatment delays and should not be interpreted as proof of a causal immune-endocrine mechanism. Because tumor-cell PD-L1 TPS was unavailable, biomarker-based conclusions cannot be drawn. This hypothesis-generating observation may inform future studies and individualized decision-making in similarly complex patients. 1 Introduction The occurrence of multiple primary malignant neoplasms (MPMNs) in a single patient, defined as two or more histologically distinct primary cancers, presents a significant clinical challenge, particularly in the elderly population ( 1 ). The rising incidence of MPMNs is attributed to factors including genetic predisposition, environmental exposures, and improved diagnostic capabilities leading to longer patient survival ( 2 ). Prostate adenocarcinoma and lung squamous cell carcinoma (LUSC) are both prevalent malignancies in older men, yet their co-occurrence as synchronous primaries is relatively uncommon ( 1 ). Current guidelines for managing synchronous dual malignancies are largely extrapolated from single-tumor evidence, leaving a substantial clinical gap regarding optimal combination strategies that simultaneously address both primaries without cumulative toxicity. In particular, the integration of immunotherapy with endocrine therapy for synchronous prostate and lung cancers lacks unified guideline recommendations, and existing literature is limited to isolated case reports and small retrospective series ( 3 ). LUSC is notoriously difficult to treat in the advanced setting due to a paucity of actionable driver mutations, rendering targeted therapies like EGFR inhibitors largely ineffective, as evidenced by their low objective response rates and short progression-free survival ( 4 ). In this archival case, a tumor-cell PD-L1 TPS was not available; therefore, any relationship between PD-L1 status and treatment response cannot be assessed. This case presents a patient belonging to a particularly vulnerable subgroup rarely captured in existing reports. The patient was an elderly, non-verbal individual with significant cardiopulmonary comorbidities, including hypertension, coronary artery disease, and bronchiectasis with chronic Pseudomonas aeruginosa airway colonization, whose family declined conventional platinum-doublet intensive chemotherapy. The superimposition of three high-risk factors — advanced age with frailty, congenital deaf-mutism precluding autonomous communication, and long-standing structural lung disease — is exceedingly rare in published literature. This compound vulnerability makes the present case uniquely valuable, as it represents a population for which no established treatment paradigm exists. Standardized comprehensive geriatric assessment (CGA) objectively confirmed high frailty and chemotherapy toxicity risk, supporting a shared decision to avoid platinum-doublet intensive chemotherapy ( 5 ). Additional published evidence relevant to MPMNs, prostate cancer biology and immunomodulation, bronchiectasis, geriatric treatment tolerability, PD-L1 assessment, synchronous primary cancers, and infection control is cited in references ( 6 – 15 ). These compounded clinical dilemmas raise a critical unresolved question: For a frail elderly patient with synchronous dual primary malignancies (prostate adenocarcinoma and LUSC), who has a high predicted toxicity risk and whose family declined platinum-doublet intensive chemotherapy, and who suffers from bronchiectasis complicated by recurrent Pseudomonas aeruginosa infection, how can a low-toxicity combined regimen with non-overlapping adverse effects be selected alongside a standardized infection intervention protocol to support ongoing, but potentially interrupted, immunotherapy? This case report addresses the above question through standard-dose sintilimab monotherapy combined with persistent androgen deprivation strategy, paired with tiered anti-infective supportive care. Serial CGA was performed to stratify treatment tolerance throughout the whole course. The entire case presentation, efficacy evaluation, discussion, and conclusion are organized around this core clinical question. Notably, in clinical practice, geriatric patients frequently receive reduced doses of chemotherapy or immunotherapy in an attempt to lower adverse reactions, while this strategy remains controversial and lacks sufficient clinical evidence. In the present case, sintilimab was administered at the standard dose without dose reduction; however, treatment delivery was intermittent because of recurrent pulmonary infection. Since the patient was congenitally deaf-mute and unable to communicate independently, all medical decisions were made by his family as surrogates based on the patient’s best interests. This case contributes hypothesis-generating insights into individualized management of complex MPMNs. 2 Case presentation 2.1 Patient information A 74-year-old congenitally deaf-mute male presented to the emergency department on May 2, 2024, with a 4-day history of chest pain, left shoulder pain, and persistent cough, and was subsequently admitted to the oncology department on May 6, 2024. The patient could not verbally report symptoms, and all medical decisions were signed by his family surrogates based on the patient’s best interests. He had multiple chronic comorbidities across cardiovascular, respiratory, urinary, and neurological systems: long-standing hypertension and coronary artery disease managed with oral amlodipine besylate 2.5 mg daily and atorvastatin calcium 20 mg nightly; chronic bronchiectasis with emphysematous bullae and chronic Pseudomonas aeruginosa airway colonization; bladder diverticulum with calculi; and mild cerebral atrophy. He had no history of diabetes, cerebrovascular accidents, renal disease, major trauma, infectious diseases such as hepatitis or tuberculosis, or any known drug or food allergies. His surgical, transfusion, and vaccination histories were unremarkable. Baseline CGA confirmed high frailty risk: ECOG performance status 2, intact basic activities of daily living (ADL) but severely impaired instrumental ADL, NRS2002 score 2 with mild nutritional risk, and an age-adjusted Charlson Comorbidity Index (aCCI) score indicating high chemotherapy toxicity risk. The CARG (Cancer and Aging Resilience Group) toxicity prediction model estimated an over 85% risk of grade 3 or higher severe adverse events under platinum-doublet chemotherapy. Given this objective frailty stratification, the family declined platinum-doublet intensive chemotherapy, and a low-toxicity sequential regimen with continuous ADT was adopted. 2.2 Clinical findings 2.2.1 Physical examination and laboratory tests The patient presented with poor general status and bilateral pulmonary crackles on auscultation; digital rectal examination detected a nodular enlarged prostate with suprapubic tenderness suggestive of bladder calculi-related urinary irritation. Baseline laboratory tests revealed elevated total prostate-specific antigen (TPSA) at 24.22 ug/L (reference <4.0 ug/L) and pro-gastrin-releasing peptide (ProGRP) at 89.1 pg/mL (reference <69.2 pg/mL) on May 7, 2024. Serial changes in ProGRP, SCCA, and TPSA during the treatment course are shown in Figure 1 . Cytokeratin 19 fragment (CYFRA21-1) was within normal limits. Mild inflammatory elevation and borderline nutritional indexes were noted, with normal hepatic and renal function. Initial sputum culture was positive for Pseudomonas aeruginosa. Figure 1 Curves of changes in the patient’s serological indicators. (A) Curve of changes in Pro-gastrin-releasing peptide (ProGRP). (B) Curve of changes in Squamous cell carcinoma antigen (SCCA). (C) Curve of changes in Total prostate-specific antigen (TPSA). 2.2.2 Imaging A chest contrast-enhanced CT scan on May 3, 2024, identified a solid nodule in the anterior segment of the right upper lobe measuring 14 mm x 13 mm, which had increased in size compared to a prior scan from October 17, 2023. The lesion exhibited lobulation and spiculated margins with post-contrast enhancement, raising high suspicion for malignancy. The scan also revealed findings consistent with chronic pulmonary inflammation, bronchiectasis with possible infection in the right lower lobe, mucus plugging, pulmonary emphysema with multiple bullae, atherosclerotic changes, and right pleural thickening. A subsequent whole-abdomen contrast-enhanced CT on May 9, 2024, noted an enlarged prostate with multiple nodules, prompting further evaluation. Abdominal CT also showed bladder diverticula with calculi, increasing the risk of subsequent urinary retention. 2.2.3 Histopathology A definitive diagnosis was established via histopathological examination of biopsies obtained on May 11, 2024. A CT-guided lung biopsy of the pulmonary lesion confirmed poorly differentiated squamous cell carcinoma based on immunohistochemistry (IHC): CK(+), P40(+), TTF-1(-), with a Ki-67 index of approximately 20%. The available pathology report documented PD-1 staining with a mouse monoclonal antibody (clone MX033; Fuzhou Maixin Biotechnology Co., Ltd.) and PD-1 positivity in no more than 1% of infiltrating lymphocytes; HER2 was 0. This is distinct from tumor-cell PD-L1 testing. No tumor-cell PD-L1 assay or TPS result was available because the original 2024 slides had been archived. Concurrently, a transrectal ultrasound-guided prostate biopsy (9 cores) revealed multifocal prostatic adenocarcinoma. The Gleason score was 3 + 4 = 7 (Grade Group 2) in the left apex (60% involvement) and 3 + 3 = 6 (Grade Group 1) in several other cores. The two lesions had distinct histologic features and IHC profiles, verifying synchronous independent primary cancers and ruling out cross-organ metastasis. 2.3 Diagnostic assessment Based on the integration of clinical presentation, imaging findings, serum tumor markers, and definitive histopathology, the patient was diagnosed with synchronous double primary malignancies. Combined with the patient’s clinical manifestations, imaging characteristics, and biological behavior of the lesion, the pulmonary tumor was clinically staged as Stage I (T1N0M0); the lesion size (14 mm) conformed to the definition of T1 stage (tumor maximum diameter <=3 cm). The prostate adenocarcinoma was staged as Stage II (T2N0M0). Additional diagnoses included hypertension, coronary atherosclerotic heart disease, pulmonary emphysema with bullae, bronchiectasis, bladder diverticulum with calculus, and mild cerebral atrophy. Differential diagnoses for the pulmonary space-occupying lesion included pulmonary tuberculosis, benign pulmonary tumor, and metastatic tumor. Combined with elevated tumor markers, typical malignant imaging manifestations, and pathological biopsy results, primary lung squamous cell carcinoma was confirmed. For prostate lesions, elevated PSA and multiple prostatic nodules highly suggested prostate cancer, which was finally verified by puncture pathology. Considering the two tumors occurred simultaneously with independent pathological origins, synchronous double primary cancers were diagnosed. The patient had multiple comorbidities and poor physical tolerance, with a relatively poor long-term prognosis. 2.4 Therapeutic intervention Given the patient’s frailty and the family’s decision to decline platinum-doublet intensive chemotherapy, a three-line sequential low-toxicity regimen was designed with continuous ADT for prostate cancer throughout all treatment phases. Before systemic treatment, surgery and radiotherapy/stereotactic body radiotherapy (SBRT) were considered. Surgery was not pursued because of the patient’s frailty, significant cardiopulmonary comorbidities, and chronic structural lung disease. Radiotherapy/SBRT required reproducible immobilization and repeated treatment cooperation; this was not feasible for this congenitally deaf-mute patient with severe communication limitations despite surrogate communication and graphic explanation. After discussion, the family also declined local treatment. 2.4.1 First-line therapy (May-Aug 2024: ADT + afatinib) Combined androgen blockade with leuprorelin microspheres 3.75 mg subcutaneously every 4 weeks, abiraterone acetate 1 g orally daily, and prednisone 5 mg orally twice daily was administered for prostate cancer. For LUSC, first-line targeted therapy with oral afatinib was initiated. Oral targeted therapy was prioritized for convenient home care for this deaf-mute patient dependent on family caregivers. The patient’s hypertension and dyslipidemia continued to be managed with his existing medications. 2.4.2 Second-line therapy (Aug-Dec 2024: single-agent oral vinorelbine) In August 2024, afatinib was withdrawn due to suspected bladder involvement and drug-induced urinary retention. Consistent with baseline records and abdominal CT findings, the patient had pre-existing mechanical obstruction from prostatic nodules and bladder diverticular calculi. Afatinib’s mucosal irritating side effects aggravated lower urinary tract congestion and triggered urinary outlet obstruction. Vinorelbine was then administered orally at 20 mg twice weekly. This non-standard schedule was selected after discussion with the family because of the patient’s frailty, outpatient-care needs, and concern about treatment tolerability; ADT was maintained. However, by December 2024, follow-up imaging confirmed disease progression of the lung cancer to Stage IV (T2N2M1), with an increase in the primary lesion size and new pleural, nodal, and bony metastases. The CT images documenting the initial and progression stages are shown in Figure 2 . Figure 2 CT images of the patient at different stages (Phase 1). (A) May 3, 2024. (B) August 1, 2024. (C) . October 7, 2024. (D) December 20, 2024. 2.4.3 Third-line therapy (Dec 2024-Jun 2026: standard-dose sintilimab + ADT + bone protection) After detailed communication regarding immunotherapy efficacy and immune-related adverse event risks with the patient’s family surrogates, sintilimab 200 mg intravenously was initiated as third-line monotherapy for advanced LUSC on December 24, 2024. Although the intended schedule was every 21 days, treatment was not uninterrupted. A total of 12 administrations were recorded on December 24, 2024; January 13, February 10, March 10, April 14, July 27, September 5, October 5, and December 21, 2025; and February 3, February 28, and June 9, 2026. All doses were 200 mg, without dose reduction. The deviations from the planned q21-day schedule, including a longest interval of more than 3 months between April 14 and July 27, 2025, were due to recurrent pulmonary infections. Androgen deprivation therapy for prostate cancer was maintained (later switched to goserelin administered every 3 months to reduce outpatient frequency), and bone-targeted therapy with incadronate disodium was added monthly to manage bone metastases. Standardized sputum monitoring plus reserved anti-Pseudomonas antibiotics were arranged to support infection management. The observed dual-tumor control in this single case cannot establish that ADT enhanced PD-1 inhibitor efficacy. In accordance with the CARE guidelines, a timeline table of the whole treatment process was supplemented to clearly display all treatment nodes, medication schemes, and follow-up time points
## Related Clinical Research

- [Mortality and Predictors Among People Living with HIV Newly Enrolled in Care at Bamenda Regional H](https://medichelpline.com/clinical-feed/medrxiv-11-mortality-and-associated-factors-among-people-living-with-hiv-newly-initiated.md)
- [Parenchymal Neuro-Behçet Disease Case Report: Heterogeneous Clinical Presentations](https://medichelpline.com/clinical-feed/frontiers-in-immunology-16-parenchymal-neuro-beh-et-disease-with-heterogeneous-clinical-presentations-a.md)
- [Th17/Treg imbalance in psoriasis patients with metabolic dysfunction‑associated steatotic liver di](https://medichelpline.com/clinical-feed/frontiers-in-immunology-12-th17-treg-imbalance-and-clinical-characteristics-in-psoriasis-patients-with.md)
- [Multimorbidity with tuberculosis in Kampala: prevalence, care gaps and impact on outcomes](https://medichelpline.com/clinical-feed/medrxiv-1-multimorbidity-in-tuberculosis-and-its-impact-on-health-and-treatment-outcomes.md)
- [Measles deaths: why the ‘died with’ vs. ‘died of’ debate misses the broader issue](https://medichelpline.com/clinical-feed/stat-news-4-opinion-the-died-with-vs-died-of-measles-discussion-misses-something-very.md)

## Navigation
- [← Back to Infectious Disease Feed](https://medichelpline.com/clinical-feed/infectious-disease.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.