Long-Term Response in PD-L1-Negative Advanced Non-Small Cell Lung Carcinoma With Discontinued and Restarted Nivolumab Therapy Due to Immune-Related Adverse Event / 日本農村医学会雑誌

The patient was 67-year-old woman with non-small cell lung carcinoma (squamous cell carcinoma, T2bN2M1a, Stage IVA) who was started on fifth-line therapy with nivolumab, an immune checkpoint inhibitor. Although tumor biopsy was negative for programmed cell death ligand 1 (PD-L1), the tumor size decreased. Nivolumab had to be discontinued due to suspected immune-related adverse events (i.e., skin rash and enteritis symptoms), but the tumor size reduction persisted after discontinuation and complete response was maintained for ≥ 8 months. After disease recurrence, nivolumab therapy was restarted. The tumor size decreased, and partial response was achieved and maintained. The disease was successfully controlled for ≥ 2 years (27 courses of nivolumab), when nivolumab therapy was again discontinued due to skin rash. Despite the PD-L1-negative status, the patient achieved long-term response to nivolumab therapy. The immune-related adverse events in this case were comparable between the initial and reintroduced nivolumab therapy, suggesting that nivolumab is safe to administer over the long term.

Is glue embolization safe and effective for gastrointestinal bleeding?

Transcatheter arterial embolization using N-butyl-2-cyanoacrylate (NBCA) for gastrointestinal arterial bleeding enables higher cessation rate and lower recurrent bleeding rate compared with conventional embolic materials including gelatin sponge, metallic coil, and polyvinyl alcohol (PVA) particle. Glue embolization is particularly effective in patients with coagulopathy. Even in the lower gastrointestinal tract, ischemic bowel complications by glue embolization are comparable to other agents. Glue embolization is also effective for arterial esophageal bleeding without any serious ischemic complications although the anatomy of the esophageal artery is complex and varied. For bleeding after abdominal surgery such as pancreaticoduodenectomy or hepatic lobectomy, interventional radiologists should be careful with indicating glue embolization because the presence of fewer collateral vessels can easily result in serious ischemic complications. Modified glue such as Glubran 2 (NBCA associated with methacryloxyfulfolane) can reduce the risk of ischemic complication due to its less thermal reaction, but the outcomes seem unsatisfactory.