FDG-PET in the evaluation of response to nivolumab in recurrent non-small-cell lung cancer.
BACKGROUND
Nivolumab, an immune checkpoint inhibitor, is recently clinically applied to non-small cell lung cancer (NSCLC) treatment, and this causes T cell activation and T cell infiltration to tumor tissue through the blockade of the interaction between programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1). 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) sometimes shows false positive because of the recruitment of neutrophils, lymphocytes, and macrophages. To date, there is only one report except our case, which described the correlation between FDG-PET and nivolumab.


METHODS
We report on a 75-year-old man on nivolumab treatment for metastatic non-small cell lung cancer. He had undergone right lower lobectomy for lung adenocarcinoma in the right S8 segment 10 months prior to recurrence. Pathological findings revealed invasive adenocarcinoma, pT1bN2M0 stage IIIA. Epidermal growth factor receptor (EGFR) mutation was positive for de novo T790M and anaplastic lymphoma kinase (ALK) rearrangement was negative. Immunohistochemistry was negative for PD-L1. He underwent chemotherapy with a combination of cisplatin and pemetrexed for four cycles but developed progressive disease involving the right hemithorax, multiple lymph nodes, and multiple osseous sites. Nivolumab was instituted as a second-line chemotherapy. After six courses of this immunotherapy, FDG-PET scan showed decreased FDG uptake in each recurrent lesion despite T lymphocyte activation by nivolumab. Serum carcinoembryonic antigen (CEA) level was also remarkably decreased.


CONCLUSIONS
Nivolumab's effect on recurrent NSCLC may be monitored by PET; larger studies are needed.
Department of Chest Surgery, School of Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima, 960-1295, Japan. higuchi@fmu.ac.jp.
Mitsunori
M
Higuchi
Department of Chest Surgery, School of Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima, 960-1295, Japan.
Yuki
Y
Owada
Department of Chest Surgery, School of Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima, 960-1295, Japan.
Takuya
T
Inoue
Department of Chest Surgery, School of Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima, 960-1295, Japan.
Yuzuru
Y
Watanabe
Department of Chest Surgery, School of Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima, 960-1295, Japan.
Takumi
T
Yamaura
Department of Chest Surgery, School of Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima, 960-1295, Japan.
Mitsuro
M
Fukuhara
Department of Chest Surgery, School of Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima, 960-1295, Japan.
Takeo
T
Hasegawa
Department of Chest Surgery, School of Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima, 960-1295, Japan.
Hiroyuki
H
Suzuki
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002272:Carcinoembryonic Antigen / Q000097:blood; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D002945:Cisplatin / Q000627:therapeutic use; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage / Q000493:pharmacokinetics; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000188:drug therapy; D009367:Neoplasm Staging; D020556:Neutrophil Infiltration / Q000187:drug effects; D000077594:Nivolumab; D000068437:Pemetrexed / Q000627:therapeutic use; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000493:pharmacokinetics
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D002272:Carcinoembryonic Antigen; D019275:Radiopharmaceuticals; D000068437:Pemetrexed; D019788:Fluorodeoxyglucose F18; D000077594:Nivolumab; D002945:Cisplatin
Nivolumab; Non-small cell lung cancer; Positron emission tomography; Programmed cell death 1 (PD-1); Programmed cell death ligand 1 (PD-L1)