A Case of Pseudo-progression-like Pleurisy After Combined Treatment with Nivolumab and Ipilimumab for Lung Adenocarcinoma

DOI Web Site 11 References
  • Terashima Yuto
    Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital
  • Hisakane Kakeru
    Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital
  • Atsumi Kenichiro
    Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital
  • Terashi Naoki
    Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital
  • Suzuki Ayana
    Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital
  • Nagata Koji
    Department of Pathology, Nippon Medical School Tamanagayama Hospital
  • Seike Masahiro
    Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
  • Gemma Akihiko
    Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
  • Hirose Takashi
    Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital

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Other Title
  • ニボルマブ＋イピリムマブ投与後に胸膜炎様のpseudo-progressionを呈した肺腺癌の1例

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Abstract

<p>Background. The frequency of pseudo-progression caused by immune-checkpoint inhibitors in non-small cell lung cancer (NSCLC) is approximately 5%. Thus far, most reports of pseudo-progression in NSCLC have been due to immune-checkpoint inhibitor monotherapy. We report a case of pseudo-progression-like pleurisy after combined treatment with nivolumab and ipilimumab for lung adenocarcinoma. Case. A 70-year-old man with adenocarcinoma (pT3N0M1a, stage IVA) with pleural dissemination received combination therapy consisting of carboplatin, pemetrexed, nivolumab, and ipilimumab as first-line treatment. After treatment, he had fever, dyspnea, elevated CRP, and developed pleural effusion on the affected side. Thoracic drainage was subsequently performed. Abundant T lymphocytes with predominant CD4-positive cells infiltration were observed in pleural fluid cell-block specimens. Afterwards, his symptoms improved. No further accumulation of pleural effusion was observed, even though he continued receiving chemotherapy. Hence, he was diagnosed with pseudo-progression rather than an immune-related adverse event (irAE). Conclusion. This is the first report of pseudo-progression-like pleurisy in a lung cancer patient after combined nivolumab and ipilimumab treatment. It is important to distinguish pseudo-progression from irAE-induced pleurisy.</p>

Journal

  • Haigan

    Haigan 62 (5), 400-405, 2022-10-20

    The Japan Lung Cancer Society

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