Repeating late-phase pseudo-progression in a patient with non-small cell lung cancer treated with long-term nivolumab monotherapy; a case report

Repeating late-phase pseudo-progression in a patient with non-small cell lung cancer treated with long-term nivolumab monotherapy; a case report

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BackgroundImmune check point inhibitors (ICIs) are standard treatment for patients with non-small cell lung cancer (NSCLC).Nearly a decade has passed since nivolumab was approved by the FDA for NSCLC patients.However, long-term outcomes and clinical features remain unclear for individual cases.

Pseudo-progression is a well-known paradoxical radiological response pattern under ICI treatment which occurs when tumor index lesions regress after apparent initial progression.We herein report a unique case of NSCLC with repeating pseudo-progression in late phase treated with nivolumab monotherapy for 8.5 years.

Case presentationA 56-year-old male diagnosed with Non-sq NSCLC clinical am22 pro model stage IVA, at the left upper lobe primary lesion.The primary lesion was PD-L1 negative with no oncogenic driver mutations.He had multiple pulmonary metastases and a left adrenal gland metastasis, and subsequently, received nivolumab as third-line therapy.

After initiation of spl 2control nivolumab, the lung lesion and adrenal metastasis shrank rapidly; however, the patient experienced three late-phase pseudo-progressions in the mediastinal lymph node (LN).This patient is still receiving nivolumab with no symptoms and PS 0.Acquired resistance should be judged carefully in patients with LN-only oligo-progression to avoid unnecessary local therapies and the misjudgment of treatment.