内容紹介
Effectiveness of Nivolumab in Large-Cell Neuroendocrine Carcinoma of the Lung―A Report of Two Cases
Summary
Background: The anti-programmed death-1 antibody nivolumab is an important treatment option for non-small-cell lung carcinoma. However, its effectiveness for large-cell neuroendocrine carcinomas(LCNEC)is still controversial. Here, we report 2 cases of LCNECs that responded to nivolumab. Case 1: A 62-year-old man received chemotherapy and radiotherapy for stage ⅢA lung adenocarcinoma. One year later, another lung lesion was observed and diagnosed as LCNEC using surgical lung biopsy. Although he subsequently received some chemotherapy regimens, the patient developed new brain metastasis, expanded mediastinal lesion, and increased levels of the tumor marker pro-gastrin releasing peptide(ProGRP). We started nivolumab as the sixth-line treatment. In response, ProGRP levels significantly decreased and the mediastinal lesion became smaller. Case 2: A 55-year-old man was diagnosed with stage ⅢA LCNEC and received chemotherapy and radiotherapy. The primary lesion was controlled; however, lung metastases developed and chemotherapy was unable to control them. We provided treatment with nivolumab as the third-line therapy. The tumor marker ProGRP decreased and the lung metastases became smaller. Conclusion: Nivolumab can be a valuable treatment option for LCNEC.
要旨
背景: 抗programmed death-1抗体のニボルマブは,非小細胞肺癌の治療選択肢の一つとして広く受け入れられつつある。しかし,大細胞神経内分泌癌(large-cell neuroendocrine carcinoma: LCNEC)に対する有用性は検討されていない。われわれは,2症例のLCNECに対しニボルマブによる治療を行い,奏効したため報告する。症例1: 62歳,男性。肺腺癌,stage ⅢAに対し化学放射線治療後,新たな肺結節影が出現し,外科的肺生検でLCNECと診断された。以後複数の化学療法を行ったが,脳転移出現,縦隔の軟部陰影増大とともに腫瘍マーカー(pro-gastrin releasing peptide: ProGRP)の上昇を認めた。六次治療としてニボルマブを開始し,縦隔の軟部陰影の縮小,ProGRPの著減を得た。症例2: 55歳,男性。LCNEC,stage ⅢAに対し化学放射線治療を施行し,原発巣は制御したが肺内転移で再発した。化学療法を繰り返したが増悪し,三次治療としてニボルマブを開始した。腫瘍マーカーの低下,肺転移巣の縮小を認めた。結論: LCNECに対しニボルマブは有用な選択肢となり得る。
目次
Summary
Background: The anti-programmed death-1 antibody nivolumab is an important treatment option for non-small-cell lung carcinoma. However, its effectiveness for large-cell neuroendocrine carcinomas(LCNEC)is still controversial. Here, we report 2 cases of LCNECs that responded to nivolumab. Case 1: A 62-year-old man received chemotherapy and radiotherapy for stage ⅢA lung adenocarcinoma. One year later, another lung lesion was observed and diagnosed as LCNEC using surgical lung biopsy. Although he subsequently received some chemotherapy regimens, the patient developed new brain metastasis, expanded mediastinal lesion, and increased levels of the tumor marker pro-gastrin releasing peptide(ProGRP). We started nivolumab as the sixth-line treatment. In response, ProGRP levels significantly decreased and the mediastinal lesion became smaller. Case 2: A 55-year-old man was diagnosed with stage ⅢA LCNEC and received chemotherapy and radiotherapy. The primary lesion was controlled; however, lung metastases developed and chemotherapy was unable to control them. We provided treatment with nivolumab as the third-line therapy. The tumor marker ProGRP decreased and the lung metastases became smaller. Conclusion: Nivolumab can be a valuable treatment option for LCNEC.
要旨
背景: 抗programmed death-1抗体のニボルマブは,非小細胞肺癌の治療選択肢の一つとして広く受け入れられつつある。しかし,大細胞神経内分泌癌(large-cell neuroendocrine carcinoma: LCNEC)に対する有用性は検討されていない。われわれは,2症例のLCNECに対しニボルマブによる治療を行い,奏効したため報告する。症例1: 62歳,男性。肺腺癌,stage ⅢAに対し化学放射線治療後,新たな肺結節影が出現し,外科的肺生検でLCNECと診断された。以後複数の化学療法を行ったが,脳転移出現,縦隔の軟部陰影増大とともに腫瘍マーカー(pro-gastrin releasing peptide: ProGRP)の上昇を認めた。六次治療としてニボルマブを開始し,縦隔の軟部陰影の縮小,ProGRPの著減を得た。症例2: 55歳,男性。LCNEC,stage ⅢAに対し化学放射線治療を施行し,原発巣は制御したが肺内転移で再発した。化学療法を繰り返したが増悪し,三次治療としてニボルマブを開始した。腫瘍マーカーの低下,肺転移巣の縮小を認めた。結論: LCNECに対しニボルマブは有用な選択肢となり得る。