Abstract
BackgroundNivolumab, a monoclonal antibody targeting the programmed death-1 receptor, is indicated in locally advanced or metastatic non-small cell lung cancer, with progression after platinum-based chemotherapy. Up-to-now, few data are available concerning brain activity of this treatment and concomitant use of corticosteroids.Case presentationA 64-year-old caucasian man with a pulmonary adenocarcinoma associated with brain metastases received four courses of nivolumab in concomitance with a high dose of corticosteroids for his neurologic symptoms. He experienced a partial response in his brain and chest with an improvement in his general condition.Nivolumab was effective in shrinking symptomatic brain metastases, and metastases at other sites, in a patient with non-small cell lung cancer and first-line chemotherapy failure. The effect of nivolumab was obtained despite concomitant high-dose corticosteroid therapy. Combined nivolumab and high-dose corticosteroid therapy did not induce unexpected adverse events.ConclusionNivolumab and concomitant high-dose corticosteroid therapy was found to be efficient and well tolerated.
Highlights
Nivolumab, a monoclonal antibody targeting the programmed death-1 receptor, is indicated in locally advanced or metastatic non-small cell lung cancer, with progression after platinum-based chemotherapy
The standard of care for non-small cell lung cancer (NSCLC) has changed with the introduction of immune checkpoint modulators such as nivolumab, a monoclonal antibody which binds to the programmed death-1 (PD-1) receptor expressed on T cells
In phase III trials, nivolumab improved both overall survival (OS) and progression-free survival (PFS) [1], or only PFS [2] compared with docetaxel, in locally advanced or metastatic NSCLC with progression after first-line chemotherapy
Summary
The standard of care for non-small cell lung cancer (NSCLC) has changed with the introduction of immune checkpoint modulators such as nivolumab, a monoclonal antibody which binds to the programmed death-1 (PD-1) receptor expressed on T cells. In phase III trials, nivolumab improved both overall survival (OS) and progression-free survival (PFS) [1], or only PFS [2] compared with docetaxel, in locally advanced or metastatic NSCLC with progression after first-line chemotherapy In these trials, patients with unstable or untreated brain metastases were excluded and the highest permitted corticosteroid dosage was 10 mg daily prednisone (or equivalent) within the last 2 weeks. Case presentation In June 2014, a 64-year-old caucasian man with a 40 pack-year tobacco smoking history was diagnosed with stage IV, KRAS mutated (glycine substitution at the codon 12 in exon 2), adenocarcinoma of the lung He had detectable lung and mediastinal lymph node metastases but no brain metastasis. A brain computed tomography (CT) scan showed at least four brain metastases including a right frontal lesion with significant perilesional edema consistent with the neurological symptoms (Fig. 1) He received 80 mg of oral prednisolone per day. The timeline summarizes clinical history and therapeutic interventions (Fig. 3)
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