PUB014 Nivolumab- Induced Acute Lung Injury in Non-Small Cell Lung Cancer Patients

Abstract

Nivolumab (Nivo) is a promising and hopeful drug for patients with advanced lung cancer. It is one of immune checkpoint inhibitors targeting programmed cell death protein and brings about the beneficial effect for melanoma, non-small cell lung cancer and renal cell cancer. Over the next few years it is clear that immune checkpoint inhibitor therapy will play an important role in cancer therapy. In this report, we present three patterns of nivo-induced acute lung injury that have experienced in our institute. Three patterns of lung injury are as follows. Firstly, a 65-year-old male with squamous cell cancer after surgery who was administered with nivo in two weeks prior to the short breath and dyspnea. The laboratory findings showed high level of KL-6 (777 U/ml) and surfactant protein-D(1271ng/ml). On chest CT ground glass and reticular shadow were observed in the left lower lobe of the lung. Three times of pulse steroid therapy was carried out at early stage however, the patient was dead on 4 weeks after treatment of nivo. Pathological examination in the damaged lung showed the nonspecific interstitial pneumonia. Secondarly, a 69-year-old female with adenocarcinoma after surgery who was administered with nivo in two days prior to massive hemoptysis and severe respiratory dysfunction prssented. On chest CT, some massive shadows induced by acute alveolar hemorrhage at left lower lobe of lung occurred and the patient resulted in the severe respiratory failure and was dead on the same day. Lastly, A 61-year-old male with squamous cell cancer after surgery who was administered with nivo in a week without any subjective symptoms presented. On chest CT, ground glass shadow at right upper lobe of lung. The Infiltrating shadow along the bronchiovascular bundle was also observed. The pulse steroid therapy was carried out and resulted in the rapid improvement of interstitial change and inflammatory changes in the serum within a week. We have recently experienced three patterns of nivolumab-induced lung injury. As frequent use of nivo will be expected, we have to elucidate a detailed mechanism of lung injury related to this therapy as soon as possible.