Pneumonitis with Nonspecific Interstitial Pneumonia Pattern Caused by Nivolumab in a Patient with Metastatic Melanoma

Sawa K,Kawaguchi T

doi:10.4172/2165-8048.1000215

Abstract

A 67-year-old man with metastatic melanoma was treated with nivolumab, which is an antibody against programmed cell death 1 (PD-1). After the 15th course of therapy, he developed drug-induced pneumonitis with a radiologic pattern that was consistent with nonspecific interstitial pneumonia (NSIP). The treatment with glucocorticoid was initiated and his symptoms and radiologic abnormalities rapidly resolved. Early initiation of glucocorticoid can be effective in the treatment of pneumonitis caused by nivolumab. Since increased use of immune checkpoint inhibitors is expected, radiologic and clinical information on pneumonitis caused by anti-PD-1 drugs is required. Here we report our case to provide the detailed radiologic finding of pneumonitis caused by nivolumab and the clinical outcome.

Highlights

Antibodies against programmed cell death 1 (PD-1) that block inhibitory T-cell checkpoints comprise a new therapy for advanced cancers, including melanoma and non-small cell lung cancer (NSCLC) [1]
We report a case of pneumonitis with nonspecific interstitial pneumonia (NSIP) pattern associated with nivolumab in a patient with melanoma who was successfully treated with glucocorticoid
In practice, the diagnosis is usually based on the combination of clinical and radiologic findings, and the exclusion of other causes of pneumonitis such as infections, pulmonary edema, or pulmonary malignancy [10]

Summary

Introduction

Antibodies against programmed cell death 1 (PD-1) that block inhibitory T-cell checkpoints comprise a new therapy for advanced cancers, including melanoma and non-small cell lung cancer (NSCLC) [1]. We report a case of pneumonitis with nonspecific interstitial pneumonia (NSIP) pattern associated with nivolumab in a patient with melanoma who was successfully treated with glucocorticoid. After the 5th cycle of treatment, a new nodule was found in his abdomen with diagnosis of metastatic malignant melanoma He was treated with nivolumab (2 mg/kg every 3 weeks). We started glucocorticoid therapy with 1 mg/kg prednisolone on the 3rd day of admission After starting this treatment, his fever, respiratory symptoms and hypoxemia immediately remitted and the interstitial shadows on the chest X-ray disappeared. A follow-up CT on days 28 showed resolving radiologic findings (Figure 2) We diagnosed this as druginduced pneumonitis with NSIP pattern caused by nivolumab. The prednisolone was gradually tapered over 2-month period and the patient was in good condition on days 76

Discussion

Findings

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