Pseudoprogression in Non-Small Cell Lung Cancer Brain Metastases Attributable to the Anti-PD-1 Antibody Nivolumab

John Sooraj,Rose Trevor A,Antonia Scott J,Creelan Ben C

doi:10.36959/825/574

Abstract

Pseudoprogression in Non-Small Cell Lung Cancer Brain Metastases Attributable to the Anti-PD-1 Antibody Nivolumab

Highlights

Nivolumab is a fully human immunoglobulin G4 Programmed Death Protein 1 (PD-1) antibody which binds to the PD-1 receptor of activated human T-cells with high affinity, thereby blocking interaction with its shared ligands
In a pilot study of stereotactic radiation of small brain metastases, radiation effects required a median of 8 months to become clinically apparent and imaging changes persisted for months, even after initiation of vitamin E/pentoxifylline [9]
Pseudoprogression of previously irradiated brain metastases is a rare but notable phenomenon associated with anti-PD-1 therapy

Summary

Introduction

Nivolumab is a fully human immunoglobulin G4 Programmed Death Protein 1 (PD-1) antibody which binds to the PD-1 receptor of activated human T-cells with high affinity, thereby blocking interaction with its shared ligands. Craniotomy with gross total resection of the left cerebellar metastasis revealed poorly differentiated lung adenocarcinoma with a KRASG12C mutation, TTF1 +, Napsin A +, CK7 +, CK20 - and was strongly positive for membranous PD-L1 expression in tumor cells by immunohistochemistry (Dako, Clone 28-8) She received Stereotactic Radiosurgery (SRS) using the Brainlab Novalis® TX (Heimstetten, Germany), consisting of single fractions of 2,200 Centigray (cGy) to each of the three remaining brain lesions. Forty-two days later, she began nivolumab mono therapy (3 mg/kg) intravenous infusion every 2 weeks on a clinical trial She experienced severe headache 7 days after her first infusion, and imaging revealed worsened edema with interval enlargement of enhancing brain metastases (Figure 1C). More than 2 years later, she continues to receive nivolumab every 2 weeks, without any further toxicity

Discussion

Findings

Conclusion