Metastatic Lung Adenocarcinoma Complicated by Severe Nivolumab Pneumonitis

This lung cancer diagnosis at a glance

Stage at diagnosis
Stage IV
Subtype
Adenocarcinoma
Biomarkers
Microsatellite stable; low tumor mutation burden; PD-L1 70%
Sex
Male
Treatment
chemotherapy, radiation, surgery and immunotherapy

Treatment course, step by step

  1. He received concurrent cisplatin and etoposide with 50.4 Gy radiation in 28 fractions, followed by right lobectomy.
  2. After metastatic progression, nivolumab 240 mg every 2 weeks was started.
  3. Severe steroid-refractory pneumonitis later improved with infliximab.

What happened, in summary

A 66-year-old man was diagnosed with Stage IIIA adenocarcinoma of the right upper lung, classified as T3N2M0. He received cisplatin and etoposide with 50.4 Gy of radiation in 28 fractions, followed by removal of the right upper lobe.

Several months later, the cancer progressed at multiple new sites and was classified as Stage IV. Testing showed a microsatellite-stable tumor with low tumor mutation burden and PD-L1 expression of 70%. Nivolumab 240 mg every 2 weeks was started.

On day 126 of nivolumab, he was admitted with worsening shortness of breath, severe fatigue, and nausea. Infection and cancer progression were not evident, and lung inflammation extended beyond the previous radiation field. The pneumonitis did not respond adequately to corticosteroids. Infliximab was then used and improved the severe treatment-related lung inflammation.

Where this story comes from

This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full

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