Case report on ivonescimab for EGFR-TKI-resistant lung adenocarcinoma with pericardial effusion

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Frontiers in Medicine Published May 13, 2026 Medically reviewed May 13, 2026 Study authors: Chen Zhu, Hui Yu, Ying Gu, Tingshu Jiang DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider ivonescimab as a reported option for EGFR-TKI-resistant lung adenocarcinoma with pericardial effusion, noting the evidence is from a single case.

This publication is a case report and literature review concerning a 77-year-old female with a 19-year history of postsurgical left lung adenocarcinoma, now with EGFR-TKI-resistant disease and malignant pericardial effusion. The report describes the use of ivonescimab monotherapy at 800 mg intravenously every 3 weeks. After six cycles of treatment, the authors noted a marked reduction in mediastinal tumor size, resolution of pericardial effusion, and a decreasing trend in serum tumor markers (CYFRA 21-1 and proGRP). The treatment was well-tolerated with no significant adverse events observed. The authors acknowledge this is a single-patient experience and note that the practice relevance is that ivonescimab may represent a viable treatment option for this challenging population. Key limitations include the lack of a comparator, the absence of reported follow-up duration beyond six cycles, and the inherent constraints of a case report, which cannot establish efficacy or safety for broader use.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Ivonescimab is a first-in-class bispecific antibody targeting PD-1 and VEGF, showing promise in non-small cell lung cancer (NSCLC). This case report aims to explore the feasibility and efficacy of ivonescimab monotherapy in an elderly patient with EGFR-TKI-resistant advanced lung adenocarcinoma complicated by malignant pericardial effusion. A 77-year-old female with a 19-year history of postsurgical left lung adenocarcinoma was admitted with dyspnea and edema. Disease progression was observed after four cycles of chemotherapy (docetaxel plus nedaplatin) and subsequent EGFR-TKI therapy (icotinib and later furmonertinib combined with anlotinib). Upon readmission in February 2025 due to aggravated dyspnea, imaging revealed significant mediastinal tumor enlargement and a large pericardial effusion. Cytopathological examination of the pericardial fluid confirmed the presence of malignant cells, indicating TKI resistance. Given her advanced age and poor performance status precluding further chemotherapy, the patient was started on ivonescimab monotherapy (800 mg intravenously every 3 weeks). After six cycles of treatment, a follow-up CT scan demonstrated a marked reduction in the mediastinal tumor size and resolution of the pericardial effusion. Serum tumor markers, such as CYFRA 21–1 and proGRP, showed a decreasing trend. The treatment was well-tolerated with no significant adverse events observed during the follow-up periodstoryliter. This case suggests that ivonescimab monotherapy can achieve disease control with an acceptable safety profile in an elderly, heavily pretreated NSCLC patient with EGFR-TKI resistance and malignant pericardial effusion. It may represent a viable treatment option for this challenging population.