Along with inhalation of oxygen, the patient was subjected to methylprednisolone pulse therapy (1000?mg daily for 3?days) followed by prednisolone treatment (30?mg daily), which resulted in the regression of pulmonary lesions, and facilitated the tapering of prednisolone dose. Open in a separate window Fig. high incidence of drug-induced pneumonitis with early onset, supporting the need for renewed attention to nivolumab-induced pneumonitis, particularly in patients with a history of heavy antitumor treatments. mutation or the rearrangement. The patient underwent 6 lines of chemotherapeutic regimens: 4?cycles of 1st-line chemotherapy with cisplatin, pemetrexed, and bevacizumab, followed by 4?cycles of maintenance treatment with pemetrexed and bevacizumab; 4?cycles of 2nd-line docetaxel monotherapy; 4?cycles of 3rd-line chemotherapy with carboplatin and nanoparticle albumin-bound paclitaxel; 4th-line treatment with erlotinib for 6?months; 4?cycles of the 5th-line chemotherapy with gemcitabine and vinorelbine; and 6th-line treatment with tegafur/gimeracil/oteracil monotherapy for 5?months. Furthermore, a 7th-line treatment with nivolumab (3?mg/kg) was initiated due to deterioration of the patients lung cancer (rT3N3M1b) 10?months after palliative irradiation for tumor invasion of the chest wall (16 fractions to a total of 40?Gy) and 7?months after stereotactic radiosurgery for metastatic brain tumors. On the 14th day of the initial nivolumab treatment, the patient had developed dyspnea, and new non-segmental GGOs with a predominant subpleural distribution in both lungs, as determined via CT scans (Fig.?3a). Based on these imaging findings, the clinical course, and negative results of sputum cultures, urinary antigen tests, the -D glucan value, and viral antibody tests, this patient was diagnosed with grade 3 nivolumab-induced pneumonitis with a COP pattern. Prednisolone treatment (30?mg daily) was initiated, which was subsequently decreased because of improvement of the patients symptoms. However, the BQ-788 pneumonitis was exacerbated when prednisolone was administered at a dose of 5?mg daily. While the predominant lesion in the right lung was reduced in the initial disease episode, a new lesion with similar opacity was observed in the left lung at the time of relapse (Fig. ?(Fig.3b).3b). After the dose of prednisolone was raised to 60?mg daily, the pneumonitis clearly regressed, allowing for the tapering of prednisolone dose again. Open in a separate window Fig. 3 Computed tomography images of nivolumab-induced pneumonitis in Case 3. a Non-segmental ground-glass opacities and consolidations were observed in a predominantly subpleural distribution at both lungs on the 14th day of the initial nivolumab treatment. b After the predominant lesion at the right lung in the initial disease episode was reduced, the similar opacity was newly observed at the left lung in the time of relapse Patient 4 A 58-year-old man with a heavy smoking history (52.5 pack-years) was admitted for left cervical pain. After biopsy of lesions in the pyriform sinus of the hypopharynx, the patient was diagnosed with a hypopharyngeal squamous cell carcinoma (cT3N2cM0). Following induction chemotherapy with cisplatin, docetaxel, and 5-FU, the patient underwent seven cycles of the concurrent cetuximab and radiation therapy, and BQ-788 experienced complete response to treatment. He received 9?cycles of BQ-788 combination chemotherapy with nedaplatin, cetuximab, and tegafur/gimeracil/oteracil because of a recurrence in the left deep cervical lymph node after seven months. Thereafter, 49?cycles of combination chemotherapy with paclitaxel and cetuximab was initiated, but resulted in progressive disease BQ-788 from enlarged metastasis of left deep cervical lymph node. On the 4th day of the 2nd cycle of nivolumab treatment (3?mg/kg), the patient exhibited malaise and exertional dyspnea symptoms, and CT results showed multiple GGOs and consolidations in both lungs (Fig.?4). Based on the imaging results and clinical course, he was diagnosed with respiratory insufficiency caused by nivolumab-induced pneumonitis (grade 3). Sputum cultures, urinary antigen tests, the -D glucan value, and viral antibody tests were all negative. Along with inhalation of oxygen, the patient was subjected Gdf11 to methylprednisolone pulse therapy (1000?mg daily for 3?days) followed by prednisolone treatment (30?mg daily), which resulted in the regression of pulmonary lesions, and facilitated the tapering of prednisolone dose. Open in a separate window Fig. 4 Computed tomography images of nivolumab-induced pneumonitis in Case 4. Multiple consolidations and ground-glass opacities developed at both lungs Discussion and conclusions Treatment with nivolumab induces a variety of adverse events, including irAEs which can sometimes be serious or fatal, albeit infrequent. Among them, pneumonitis is one of the.
Along with inhalation of oxygen, the patient was subjected to methylprednisolone pulse therapy (1000?mg daily for 3?days) followed by prednisolone treatment (30?mg daily), which resulted in the regression of pulmonary lesions, and facilitated the tapering of prednisolone dose