内容紹介
Summary
A 71-year-old woman was diagnosed with stage ⅢB locally advanced lung squamous cell cancer(cT0N3M0). Programmed death-ligand 1(PD-L1)immunostaining was negative. First-line nedaplatin plus docetaxel and second-line carboplatin plus nab-paclitaxel were followed by sequential thoracic radiation therapy(60 Gy). The patient developed radiation pneumonitis, but her condition improved with corticosteroids. However, chest computed tomography(CT)revealed multiple nodules in both lungs. Third-line carboplatin plus tegafur/gimeracil/oteracil potassium(S-1)was not successful, and fourth-line nivolumab(3 mg/kg every 2 weeks)was adopted. On day 9 after first administration, she developed fever and radiation recall pneumonitis. Multiple nodules rapidly formed, but they later gradually decreased in number. After 13 courses of nivolumab, the nodules had disappeared completely. Mediastinal lymph nodes decreased in size, but an abdominal lymph node remained enlarged. Nivolumab was continued, and after 24 courses, the abdominal lymph node began to shrink, and the multiple lung metastases continued to disappear. Currently, the best overall response is good partial response to nivolumab.
要旨
症例は71歳,女性。肺扁平上皮癌(cT0N3M0),stage ⅢB。programmed death-ligand 1(PD-L1)発現0%。nedaplatin+docetaxel,carboplatin+nab-paclitaxel後に根治的胸部放射線照射60 Gy施行。放射線肺臓炎を発症したがステロイドにより軽快した。多発肺内転移で再発した後,carboplatin+tegafur/gimeracil/oteracil potassium(S-1)もPDとなり四次治療でnivolumab(3 mg/kg,2週毎)を開始した。初回投与9日目に発熱とradiation recall pneumonitis様の陰影を伴う肺内転移の著明な増大を認めたが増大は一過性であり,その後縮小に転じた。13コース終了時には肺内転移は消失した一方で腹部リンパ節転移のみ増大を示していたが,24コース終了時には腹部リンパ節も縮小に転じていた。good partial responseで再発所見なく約1年間の治療を継続している。
目次
A 71-year-old woman was diagnosed with stage ⅢB locally advanced lung squamous cell cancer(cT0N3M0). Programmed death-ligand 1(PD-L1)immunostaining was negative. First-line nedaplatin plus docetaxel and second-line carboplatin plus nab-paclitaxel were followed by sequential thoracic radiation therapy(60 Gy). The patient developed radiation pneumonitis, but her condition improved with corticosteroids. However, chest computed tomography(CT)revealed multiple nodules in both lungs. Third-line carboplatin plus tegafur/gimeracil/oteracil potassium(S-1)was not successful, and fourth-line nivolumab(3 mg/kg every 2 weeks)was adopted. On day 9 after first administration, she developed fever and radiation recall pneumonitis. Multiple nodules rapidly formed, but they later gradually decreased in number. After 13 courses of nivolumab, the nodules had disappeared completely. Mediastinal lymph nodes decreased in size, but an abdominal lymph node remained enlarged. Nivolumab was continued, and after 24 courses, the abdominal lymph node began to shrink, and the multiple lung metastases continued to disappear. Currently, the best overall response is good partial response to nivolumab.
要旨
症例は71歳,女性。肺扁平上皮癌(cT0N3M0),stage ⅢB。programmed death-ligand 1(PD-L1)発現0%。nedaplatin+docetaxel,carboplatin+nab-paclitaxel後に根治的胸部放射線照射60 Gy施行。放射線肺臓炎を発症したがステロイドにより軽快した。多発肺内転移で再発した後,carboplatin+tegafur/gimeracil/oteracil potassium(S-1)もPDとなり四次治療でnivolumab(3 mg/kg,2週毎)を開始した。初回投与9日目に発熱とradiation recall pneumonitis様の陰影を伴う肺内転移の著明な増大を認めたが増大は一過性であり,その後縮小に転じた。13コース終了時には肺内転移は消失した一方で腹部リンパ節転移のみ増大を示していたが,24コース終了時には腹部リンパ節も縮小に転じていた。good partial responseで再発所見なく約1年間の治療を継続している。