ABSTRACT
Immune checkpoint inhibitors (ICIs) represent a new standard of care for patients with advanced nonsmall cell lung cancer, improving overall survival compared with standard chemotherapy. However, a new pattern of response to ICIs characterized by accelerated tumor growth has been recently described, termed hyperprogressive disease (HPD). We report the case of a 73-year-old patient with advanced lung adenocarcinoma who developed HPD following treatment with a unique dose of atezolizumab for a skin metastasis that was refractory to chemotherapy and radiotherapy. Potential clinical biomarkers related to HPD to ICIs are reviewed.
Subject(s)
Adenocarcinoma of Lung/drug therapy , Antineoplastic Agents, Immunological/adverse effects , Immunotherapy/adverse effects , Lung Neoplasms/drug therapy , Skin Neoplasms/radiotherapy , Adenocarcinoma of Lung/pathology , Aged , Antibodies, Monoclonal, Humanized/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Humans , Lung Neoplasms/pathology , Male , Shoulder/pathology , Skin Neoplasms/drug therapy , Skin Neoplasms/secondaryABSTRACT
Advances in immunotherapy have changed the therapeutic landscape of non-small cell lung cancer (NSCLC), extending overall survival over standard chemotherapy. However, by removing the protection against autoimmunity, immunotherapy can increase immune-related adverse events (irAEs). In addition, new patterns of radiological response have been observed in patients treated with immune checkpoint inhibitors (ICIs). We report the case of a 77 year-old patient with advanced lung adenocarcinoma, who presented three consecutive different irAEs (nephritis, hepatitis, and pneumonitis) and an atypical radiological response (partial response, dissociated response, and "disease flare") in relation to treatment with the PD-1 inhibitor nivolumab. The role of ICIs in elderly patients, the incidence of consecutive irAEs, and the new patterns of radiological response, are also reviewed.
