title: Immune checkpoint inhibitors and response analysis: a tough challenge. A case report.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Medical Oncology A, Department of Medical Oncology, Centro di Riferimento Oncologico, National Cancer Institute of Aviano, Via Franco Gallini 2, 33081, Aviano, PN, Italy. abearz@cro.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bearz
authors.affiliation: Division of Pathology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, PN, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Perin
authors.affiliation: Division of Radiology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, PN, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cancian
authors.affiliation: Clinical Trial Office, Scientific Directorate, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, PN, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Berto
authors.affiliation: Clinical Trial Office, Scientific Directorate, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, PN, Italy.
authors.forename: Ivana
authors.initials: I
authors.lastname: Sartor
authors.affiliation: Division of Medical Oncology A, Department of Medical Oncology, Centro di Riferimento Oncologico, National Cancer Institute of Aviano, Via Franco Gallini 2, 33081, Aviano, PN, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Tirelli
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D000077192:Adenocarcinoma of Lung; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D060890:B7-H1 Antigen / Q000037:antagonists & inhibitors / Q000235:genetics / Q000276:immunology; D001706:Biopsy; D002945:Cisplatin / Q000627:therapeutic use; D018450:Disease Progression; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology / Q000556:secondary; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D008198:Lymph Nodes / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D016246:Lymphocytes, Tumor-Infiltrating; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D014057:Tomography, X-Ray Computed
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D060890:B7-H1 Antigen; C423236:CD274 protein, human; D002945:Cisplatin
keywords: Immune-checkpoint inhibitors; NSCLC; Radiologic response