Stage IV lung cancer response followed by immune-related lung inflammation

What happened, in summary

A 74-year-old man with a smoking history developed cough and mild coughing of blood. Imaging showed a left upper-lung mass, mediastinal lymph nodes, and pleural involvement. Biopsy confirmed squamous cell lung cancer. The disease was Stage IV, and testing did not find EGFR, ALK, or ROS1 driver alterations.

He received 4 cycles of paclitaxel, carboplatin, and tislelizumab. Follow-up imaging showed that the left-lung lesions had become smaller, but new cavities appeared in the right lung.

A lung biopsy showed inflammatory changes rather than cancer, and extensive testing did not identify an infection. His doctors considered the findings immune-related pneumonitis from treatment. He was treated with corticosteroids, and repeat imaging after 3 weeks showed that the cavities and the lung mass had both decreased.

He did not receive further tumor-directed chemotherapy, immunotherapy, or radiation after this complication. He later pursued traditional Chinese medicine at another hospital and was described as being in generally good condition.