Suyanto Suyanto, Yeo Daniel, Khan Sarah
Nottingham University Hospital NHS Trust, UK.
Case Rep Oncol Med. 2019 Mar 3;2019:8356148. doi: 10.1155/2019/8356148. eCollection 2019.
Immune checkpoint inhibitors such as Nivolumab work by preventing the inactivation of host T-cells by tumour cells, thereby allowing the T-cells to attack the tumour cells, which results in tumour tissue necrosis. We describe a 78-year-old woman with metastatic lung adenocarcinoma treated with Nivolumab after disease progression following first-line chemotherapy. Computed tomography (CT) after 3 cycles showed a smaller left lower lobe (LLL) primary and stable right lower lobe (RLL) metastatic lesion. CT after 9 cycles showed a reduced RLL mass and an increase in LLL primary. However, CT after 15 cycles showed that the RLL mass had further reduced in size but the LLL mass was significantly larger. The biopsy of the LLL lesion showed necrotic areas and reactive inflammatory changes, without residual malignancy. A repeat CT after further 4 cycles confirmed tumour regression in both the primary and the metastatic lesions. There was a prior reported case of pseudoprogression in a non-small-cell lung cancer patient who had 7 cycles of Nivolumab, and it was diagnosed during a further line of chemotherapy. Here, we report a patient with pseudoprogression during treatment with Nivolumab and at a much later time, after 15 cycles.
纳武单抗等免疫检查点抑制剂的作用机制是阻止肿瘤细胞使宿主T细胞失活，从而使T细胞能够攻击肿瘤细胞，导致肿瘤组织坏死。我们描述了一名78岁的转移性肺腺癌女性患者，在一线化疗疾病进展后接受了纳武单抗治疗。3个周期后的计算机断层扫描（CT）显示左下叶（LLL）原发灶变小，右下叶（RLL）转移灶稳定。9个周期后的CT显示RLL肿块缩小，LLL原发灶增大。然而，15个周期后的CT显示RLL肿块进一步缩小，但LLL肿块明显增大。LLL病变的活检显示有坏死区域和反应性炎症改变，无残留恶性肿瘤。再经过4个周期后的重复CT证实原发灶和转移灶的肿瘤均消退。此前有一例非小细胞肺癌患者在接受7个周期的纳武单抗治疗后出现假进展的报道，且是在后续化疗期间确诊的。在此，我们报告一名在接受纳武单抗治疗15个周期后出现假进展的患者，且时间要晚得多。
