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Vol.60 No.7 contents | Japanese/English |
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- Case Report -
A Case of Lung Cancer That Developed Extensive Pulmonary Necrosis During Durvalumab Treatment
Masami Orinaka1, Toshiyasu Ito1, Yohei Tsunoda1, Azusa Ishii1, Sayaka Kato1, Takafumi Kayukawa1, Masahiro Kobayashi1, Shoko Miyamatsu1, Yoshio Ryuge1, Shuichi Asano11Department of Respiratory Medicine, Japan Community Health Care Organization Chukyo Hospital, Japan
Background. Durvalumab is effective as a consolidation therapy after radical chemoradiotherapy and is being used as the standard treatment for unresectable stage III non-small cell lung cancer. However, managing pulmonary toxicity, a major adverse event, is important during durvalumab treatment. Case. A 65-year-old man with squamous cell carcinoma of the right upper lobe (cT3N1M0) received concurrent chemoradiotherapy as an initial treatment. The tumor reduced in size; therefore, durvalumab treatment was started seven days after the completion of radiation therapy. The patient developed a fever and right chest pain after eight courses of durvalumab administration; chest computed tomography (CT) showed a broadly infiltrating shadow and ground-glass opacities predominantly in the right upper lobe. Although steroid therapy was started along with antibiotic administration, the infiltrating shadow changed to a broad cavity on a repeated CT examination performed eight days later. The cavity was consistent with the irradiation field and extended beyond the interlobar region, and the interlobar pleura inside the cavity remained. No significant pathogens were detected on bronchoscopy. His condition deteriorated because of infection and disseminated intravascular coagulation, and he died about one month after the appearance of lung injury. Based on the clinical course and autopsy findings, lung injury and pulmonary necrosis were considered to have resulted from the use of durvalumab and irradiation. Conclusion. We experienced a case of non-small cell lung cancer that developed extensive lung necrosis during durvalumab treatment after chemoradiotherapy.
key words: Non-small cell lung cancer, Immune checkpoint inhibitor, Durvalumab, Chemoradiation therapy, Pulmonary necrosis
Received: June 17, 2020
Accepted: August 12, 2020
JJLC 60 (7): 985-990, 2020
