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Case Reports
. 2018 Jun 15;57(12):1773-1777.
doi: 10.2169/internalmedicine.0002-17. Epub 2018 Feb 9.

The Significant Antitumor Activity of Nivolumab in Lung Adenocarcinoma With Choriocarcinomatous Features

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Free PMC article
Case Reports

The Significant Antitumor Activity of Nivolumab in Lung Adenocarcinoma With Choriocarcinomatous Features

Mieko Ochi et al. Intern Med. .
Free PMC article

Abstract

We report the case of a 60-year-old Japanese man with a metastatic brain tumor that caused ataxia. As a consequence of resection of a cerebellar tumor, the tumor was diagnosed as a poorly differentiated adenocarcinoma with choriocarcinomatous features. The patient underwent bronchoscopy, leading to a diagnosis of the same histology as the brain tumor. After the administration of first-line chemotherapy and maintenance therapy due to progressive disease, he was given nivolumab and obtained a partial response; however, 11-months later, computed tomography showed tumor progression. Our experience suggests that nivolumab has strong activity, even in patients with a rare form of lung cancer.

Keywords: PD-1; PD-L1; acquisition of resistance; choriocarcinoma; nivolumab.

Figures

Figure 1.
Figure 1.
Magnetic resonance imaging at the first visit showing cerebellar metastasis.
Figure 2.
Figure 2.
A chest radiograph showing a mass shadow in the right upper lung field (A), and computed tomography (CT) of the chest showing ipsilateral mediastinal and hilar lymphadenopathy (B). Large arrows indicate mass shadows. Small arrows indicate ipsilateral mediastinal and hilar lymphadenopathy.
Figure 3.
Figure 3.
Cerebellar metastasis of lung adenocarcinoma (A, B). The primary lesion shown by bronchoscopy (C, D). The expression of hCG and TTF-1. (B, D). Representative micrographs of the tumors. Hematoxylin and Eosin staining at an original magnification of ×20 and bizarre multinucleated giant cells are indicated by black and white arrows, respectively (A, C). The focal expression of hCG shown at an original magnification of ×20. Both specimens showed poorly differentiated adenocarcinoma with choriocarcinomatous features. Only the choriocarcinomatous features of the metastatic lesion were positive for hCG. Both the adenocarcinoma component and the choriocarcinomatous features of both lesions were positive for TTF-1 at an original magnification of ×40.
Figure 4.
Figure 4.
Computed tomography showing the significant regression of the tumor in the lung after chemotherapy. A) At the start of first-line chemotherapy. CT showed a partial response before maintenance therapy. (B) The size of the tumor in the lung increased after 5 months (C). The patient started treatment with nivolumab as second-line chemotherapy. (D) A partial response was obtained after the first four cycles (E). CT showing progressive disease in a pulmonary lesion at the end of the 25th cycle (F).
Figure 5.
Figure 5.
Anti-PD-L1 immunostaining (PD-L1 IHC 22C3 pharmDx and PD-L1 IHC 28-8 pharmDx) of the bronchoscopy and specimen and a specimen of the resected tumor (A). Membrane staining of the bronchoscopy specimen. More than 50% of the tumor cells (including adenocarcinoma component and choriocarcinomatous features) were positively stained (B). Membrane staining of the resected specimen. Less than 50% of the tumor cells were positively stained.

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