Pseudoprogression in lung adenocarcinoma during treatment with nivolumab

Description

A 64-year-old male was diagnosed with clinical stage IV lung adenocarcinoma. Biopsy was negative for both epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement. We administered five lines of chemotherapy. The disease continued to progress (figure 1A), and the patient received antiprogrammed death(PD)-1 antibody (nivolumab, scheduled at 3 mg/kg once every 2 weeks). After 2 months, he received supportive care due to progression (figure 1B). After 1 month, CT demonstrated a decrease in the size of the lung cancer and metastases (figure 1C). We concluded that this was an atypical response, or pseudoprogression, caused by the immunotherapeutic agent. After 2 months, nivolumab was reinitiated due to progression (figure 2A). After 1 month, the cancer increased in size (figure 2B), and the histopathology of the specimen obtained from the left cervical lymph nodes showed tumour cells and a mild...

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