Stage III lung cancer treatment complicated by immune-related lung inflammation

What happened, in summary

A 61-year-old man developed cough and mild coughing of blood. Imaging found a large right upper-lung mass involving the pulmonary artery, and biopsy confirmed squamous cell lung cancer. The cancer was Stage III, and testing did not find EGFR, ALK, or ROS1 driver alterations.

He received 3 cycles of paclitaxel, carboplatin, and pembrolizumab, and the lung mass became smaller. He then developed a new lung cavity and chest pain. Biopsy showed organizing pneumonia rather than cancer, and infection testing was negative. His doctors considered this an immune-related lung complication and treated him with corticosteroids.

After the inflammation improved, he underwent right upper lobectomy followed by 2 additional cycles of chemotherapy. In 2022, enlarged mediastinal lymph nodes appeared and he received further chemotherapy with durvalumab, followed by durvalumab alone.

The mediastinal nodes later enlarged again. He received mediastinal radiation and subsequently additional immunotherapy with intermittent chemotherapy. The immune-related lung inflammation did not recur.