Redefining Therapeutic Boundaries: PD-1 Blockade Facilitates Surgical Cure in EGFR-TKI Refractory EGFR-Mutant NSCLC with Pleural Metastases.

We present a 57-year-old female diagnosed with stage cT3N1M1a (IVA) EGFR L858R-mutant lung adenocarcinoma (PD-L1 TPS 60%). The patient attained sustained disease control with a partial response lasting 22 months on first-line gefitinib. Following progression with persistent EGFR L858R mutation, second-line platinum-pemetrexed-bevacizumab chemotherapy achieved stable disease (SD) in the primary lesion and shrinkage of pleural nodules. Subsequent neoadjuvant therapy with albumin-bound paclitaxel, carboplatin, bevacizumab, and sintilimab induced marked tumor regression, permitting curative-intent R0 resection. Histopathological analysis confirmed ypT0N0, indicating a pathological complete response (pCR). The patient remained recurrence-free 25 months post-surgery. This case illustrates the potential of immunotherapy-based neoadjuvant regimens to convert unresectable PD-L1-high EGFR-mutant lung adenocarcinoma into operable disease and achieve durable pCR.