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Vol.59 No.1 contents | Japanese/English |
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- Case Report -
A Case of Pseudoprogression in Lung Adenocarcinoma Treated with Nivolumab
Atsushi Nakamura1, Tomoiki Aiba1, Sachiko Kawana1, Ryohei Saito1, Yukihiro Toi1, Shunichi Sugawara11Department of Respiratory Medicine, Sendai Kousei Hospital, Japan
Background. Immune-checkpoint inhibitors are an effective treatment option for non-small cell lung cancer. However, in contrast to observations with cytotoxic anticancer agents, pseudoprogression-wherein tumors reduce in size after an apparent increase-is occasionally noted with immune-checkpoint inhibitors. Case. A 57-year-old man was diagnosed with postoperative recurrence of lung adenocarcinoma. Nivolumab was administered as third-line treatment. He developed an infusion reaction just after the first course. After four courses, the inside part of the tumor appeared to be of low density on computed tomography (CT). Given that the tumor had increased in size, progressive disease (PD) was considered. However, we continued administering nivolumab, as his tumor marker levels had decreased. After eight courses, the tumor diameter increased further; however, the low-density area in the tumor had also increased, with a further decrease in the tumor marker level. The patient's whole-body state showed a trend towards improvement; we therefore judged the treatment to be effective. After 12 courses, the tumor finally reduced in size and showed a partial response (PR). Conclusion. Distinguishing true progress from pseudoprogression is important when immune-checkpoint inhibitors are used for treatment. Even if imaging findings suggest PD, parameters such as a decrease in the tumor marker levels, the appearance of a low-density area in the tumor, and the occurrence of immune-related adverse events (irAEs) should be considered. The possibility of pseudoprogression should be considered when deciding whether or not to continue treatment with immune-checkpoint inhibitors.
key words: Lung cancer, Immune-checkpoint inhibitor, Nivolumab, Pseudoprogression, irAE
Received: July 9, 2018
Accepted: November 12, 2018
JJLC 59 (1): 60-65, 2019
