ABSTRACT
The incidence rate of pseudoprogression during immune checkpoint inhibitor monotherapy for non-small cell lung cancer is reportedly 3.6%-6.9%, while pseudoprogression during chemoimmunotherapy is rare. Reports on pseudoprogression during dual immunotherapy combined with chemotherapy are lacking. Herein, a 55-year-old male with invasive mucinous adenocarcinoma (cT2aN2M1c [OTH, PUL], stage IVB, and programmed death-ligand 1 expression <1%), renal dysfunction, and disseminated intravascular coagulation was treated with carboplatin, solvent-based paclitaxel, nivolumab, and ipilimumab. After treatment initiation, computed tomography (CT) on day 14 showed disease progression. The patient was diagnosed with pseudoprogression because of a lack of symptoms, improved platelet count, and decreased fibrin/fibrinogen degradation product levels. CT on day 36 showed a reduction in the primary lesion size, multiple lung metastases, and mesenteric metastases. Therefore, pseudoprogression should be considered during dual immunotherapy with chemotherapy.
ABSTRACT
Pulmonary pleomorphic carcinoma (PPC) is well-known for its aggressive nature that is usually resistant to platinum-based chemotherapy. On the other hand, the efficacy of an immune checkpoint inhibitor-based regimen in PPC has been elucidated. PPCs harboring epidermal growth factor receptor (EGFR) mutations are extremely rare, and the efficacy of EGFR-tyrosine kinase inhibitors in PPC is limited compared to their efficacy in EGFR-mutated adenocarcinoma. A 43-year-old female patient presenting with a lung mass with multiple brain metastases, carcinomatous pericarditis, and multiple bone metastases was referred to our department. Transbronchial biopsy confirmed the diagnosis of PPC harboring an EGFR mutation with exon 19 deletion. Subsequently, she was treated with osimertinib, a third-generation EGFR-tyrosine kinase inhibitor, which resulted in partial response with shrinkage of the primary lesion and brain metastases. This partial response remained durable for 11 months with an ongoing regimen. The current case suggests that osimertinib would show promising effects as a first-line treatment for PPCs harboring EGFR mutations, as well as a reasonable sequence of therapy followed by immune checkpoint inhibitor-based regimens.
Subject(s)
Adenocarcinoma , Antineoplastic Agents , Brain Neoplasms , Lung Neoplasms , Acrylamides , Adenocarcinoma/drug therapy , Adult , Aniline Compounds , Antineoplastic Agents/therapeutic use , Brain Neoplasms/drug therapy , Brain Neoplasms/genetics , ErbB Receptors/genetics , Female , Humans , Immune Checkpoint Inhibitors , Indoles , Lung/pathology , Lung Neoplasms/drug therapy , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Mutation , Protein Kinase Inhibitors/therapeutic use , PyrimidinesABSTRACT
A 59-year-old woman presented with right sensory loss and right hemiparesis. In February 2013, she was admitted to Araki Neurosurgical Hospital. A magnetic resonance imaging was performed that revealed a left temporal lobe hemorrhage. The image also showed a chronic stereotype hematoma. After 14 days of hospitalization, she underwent a stereotactic craniotomy. Subsequently, by postoperative pathological evaluation, the hematoma was diagnosed as a cavernous angioma. She had no postoperative complications. She was provided rehabilitation support and was discharged 28 days after the admission following which she rejoined work. A stereotactic craniotomy device is very useful in surgeries involving deep lesions. We present a case of stereotactic craniotomy and a few investigation reports.
