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

Terashima Yuto, Hisakane Kakeru, Atsumi Kenichiro, Terashi Naoki, Suzuki Ayana, Nagata Koji, Seike Masahiro, Gemma Akihiko, Hirose Takashi

doi:10.2482/haigan.62.400

<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>

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

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