Drastic response to nivolumab in a case demonstrating a rapid recurrence of pulmonary pleomorphic carcinoma that developed after chemotherapy for comorbid myeloma kidney

Abstract

Background. Pulmonary pleomorphic carcinoma is a highly malignant tumor showing rapid growth and is considered to be resistant to chemotherapy. We herein report a case of pleomorphic carcinoma in which nivolumab, an immune checkpoint inhibitor, was effective for controlling the tumor's rapid recurrence. Case. A 69-year-old man was diagnosed with pulmonary pleomorphic carcinoma that was initially detected in a checkup examination. Acute renal failure developed while he was waiting for surgical treatment of the lung cancer. Bone marrow tap and a renal biopsy revealed multiple myeloma and cast nephropathy, respectively. Right pneumonectomy was carried out under hemodialysis. A chest drainage tube was removed on the 6th postoperative day. Melphalan-prednisolone therapy was started on the 14th day and performed twice. On the 51st day, emergent operation was performed for intussusception caused by intestinal metastasis. On the 103rd day, metastases were found in the skin, brain, and adrenal glands. Gamma-knife radiation therapy and vinorelbine monotherapy were started. Disease progression was observed after five courses of vinorelbine. Nivolumab was introduced as the second-line therapy. After three courses, the skin metastases disappeared, and the size of bilateral adrenal metastases were reduced in size. Nivolumab was continued for 15 courses, and the rapid systemic dissemination was controlled. The patient is now receiving fifth-line chemotherapy. Conclusion. We experienced rapid systemic dissemination in a case of pleomorphic carcinoma comorbid with multiple myeloma that was successfully controlled by nivolumab.