A Case of Lung Adenosquamous Carcinoma with Drug-induced Organizing Pneumonia due to Nivolumab After Achieving a Clinical Response

Abstract

Background. Nivolumab, an immune checkpoint inhibitor, is effective for previously treated advanced non-small cell lung cancer. However, drug-induced interstitial pneumonia in nivolumab has been reported in some cases, requiring immediate management. Case. A 67-year-old woman received adjuvant chemotherapy for adenosquamous carcinoma of the lung. After six months, computed tomography (CT) revealed multiple metastases involving the bilateral lung, right kidney, and accessory nerve lymph node. Nivolumab was started and achieved a partial response. After seven cycles of treatment, CT showed multiple patchy infiltrative shadows in the bilateral subpleural areas. According to the clinical course and imaging findings, drug-induced organizing pneumonia due to nivolumab was suspected, and 30 mg/day of prednisolone was administered after discontinuing nivolumab, which promptly improved the pneumonia. Conclusion. The immediate administration of steroids is important for cases that develop drug-induced organizing pneumonia during treatment with nivolumab. (JJLC. 2019;59:53-59)