Multifocal stage IIIA lung adenocarcinoma responding to nivolumab

What happened, in summary

A 66-year-old woman was diagnosed with a separate lung cancer while undergoing staging for newly discovered right breast cancer. PET-CT showed multiple active nodules throughout the right lung. She had a 35-pack-year smoking history but no cough, chest pain, coughing of blood, shortness of breath, weight loss, or other systemic symptoms.

Biopsy of one pulmonary nodule showed primary lung adenocarcinoma with CK7, TTF-1, and napsin-A positivity. PET-CT did not show active mediastinal or hilar lymph nodes. She declined surgical sampling of the mediastinal nodes. The multifocal right-lung cancer was classified as stage IIIA, T4N0M0, and was kept separate from the synchronous triple-negative breast cancer.

She received six cycles of paclitaxel and carboplatin, a regimen selected to treat both primary cancers. The lung nodules were unchanged after chemotherapy. Testing then showed PD-L1 expression of 85%, and nivolumab was started every two weeks. After four cycles, the biopsied nodule had nearly resolved, while other areas appeared stable and scar-like.

Nivolumab continued for 16 cycles before being stopped because she developed treatment-related hepatitis. At 24 months, chest CT showed stable pulmonary nodules. She continued imaging and blood-test surveillance and described feeling well and remaining active two years after the diagnoses.