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Case Reports
. 2016 Jul 18:9:349.
doi: 10.1186/s13104-016-2153-9.

Immune checkpoint inhibitors and response analysis: a tough challenge. A case report

Alessandra Bearz  1 , Tiziana Perin  2 , Luca Cancian  3 , Eleonora Berto  4 , Ivana Sartor  4 , Umberto Tirelli  5
Affiliations
Case Reports

Immune checkpoint inhibitors and response analysis: a tough challenge. A case report

Alessandra Bearz et al. BMC Res Notes. .

Abstract

Background: Treatment of metastatic NSCLC patients with immune-checkpoint medicine is intriguing for the potential efficacy; however it may be difficult to evaluate the clinical response due to the lack of reliable immune-monitoring markers up to now and the possibility of radiological pseudo-progression.

Case presentation: Herein we report the case of a patient ex-smoker with adenocarcinoma of the lung, stage IV for liver metastases, in progression after cisplatin-based chemotherapy and treated with antiPD-L1 (MPDL3802-Roche Genentech) e.v. every 3 weeks in a clinical trial. Treatment with antiPD-L1 was well tolerated and CT scan after 6 weeks of treatment showed stabilization of mediastinal lymph nodes, while progression of liver metastases; liver progression only was confirmed by further CT-scans. Patient was asymptomatic and it was unclear if we faced a pseudo-progression in the liver or a real progression. Data about his PDL1 expression were not available because the patient was in a clinical trial. Eventually a biopsy of the liver metastasis confirmed that there was a massive neoplastic invasion with tumor infiltrating lymphocytes <5 %. We stopped anti-PD-L1 therapy due to progression.

Conclusion: Evaluation of response may be difficult with immune checkpoint inhibitors, in particular radiologic images may be a matter of debate; eventually we performed a biopsy to study tumor infiltrating lymphocytes to decide whether it was pseudo-progression or real progression.

Keywords: Immune-checkpoint inhibitors; NSCLC; Radiologic response.

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Figures

Fig. 1
Fig. 1
Metastatic localizations in the liver (VII and VIII segment) in the CT-scan of September 2014 (on the left), before treatment with antiPD-L1, and November 2014, after 6 weeks of treatment with antiPD-L1 (on the right) (H&E, ×20). The arrow shows the metastatic localization where the biopsy was performed
Fig. 2
Fig. 2
Histologic features of the metastatic infiltrate in the liver (a), and immunohistochemistry for TTF-1 (b), CD45 (c) and CD3 (d) (H&E, ×20)
See this image and copyright information in PMC

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