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Vol.61 No.3 contents Japanese/English

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Article in Japanese

- Case Report -

A Case of Pulmonary Adenocarcinoma Continuously Treated with Immune Checkpoint Inhibitor Despite Repeated Checkpoint Inhibitor Pneumonitis

Shohei Yamashita1, Takahiro Mitsumura1, Takafumi Suzuki1,2, Rie Sakakibara1, Takayuki Honda1, Yasunari Miyazaki1
1Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan, 2Internal Medicine, Kudanzaka Hospital, Japan

Background. Checkpoint inhibitor pneumonitis (CIP) has been reported as a common immune-related adverse event induced by immune checkpoint inhibitors (ICIs). There have been few reports on the efficacy and safety of ICI re-administration following drug withdrawal due to CIP. Case. A 70-year-old man diagnosed with pulmonary adenocarcinoma (cStage IVB) was treated with pembrolizumab. Although he achieved a partial response (PR), he developed grade 2 CIP and adrenocortical insufficiency after the 10th administration of pembrolizumab. CIP improved after pembrolizumab withdrawal and prednisolone (PSL) administration. Following pembrolizumab withdrawal, the left hilar lymph node increased in size. After explaining our intention to administer chemotherapy, the patient expressed a preference for the re-administration of an ICI. In addition, ICI therapy seemed to be promising in this patient due to his high expression of PD-L1 (75%) and favorable response to pembrolizumab. Due to concerns about pembrolizumab-associated CIP recurrence, atezolizumab was administered as a second-line therapy. Although CIP repeatedly developed after 6 cycles of atezolizumab, it was within the acceptable range of grade 1, and atezolizumab was eventually administered for 18 cycles without exacerbation of CIP. Conclusion. This case showed that the continuous administration of an ICI was possible despite repeated CIP.
key words: Pulmonary adenocarcinoma, Immune checkpoint inhibitor (ICI), Checkpoint inhibitor pneumonitis (CIP)

Received: January 13, 2021
Accepted: February 20, 2021

JJLC 61 (3): 201-207, 2021

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