Diffuse pseudoprogression in a patient with metastatic non-small-cell lung cancer treated with Nivolumab

A 72-year-old woman was diagnosed with metastatic non-small-cell lung cancer (NSCLC) stage IV in February 2016. The molecular analysis showed EGFRwt, KRASwt, BRAFwt, ERBB2wt and no translocation or amplification of ALK, ROS1, MET or RET. The patient was treated with Carboplatin and Pemetrexed between February and June 2016 with initial partial response. The following Pemetrexed maintenance therapy was interrupted in September 2016 due to worsening of renal function and disease progression. A second line treatment with Nivolumab (given every two weeks at 3 mg/kg) was started in October 2016. Metastases to adrenal glands and bilateral to the lungs are seen in the PET-CT scan taken at the start of Nivolumab treatment (Figure 1A). Despite development of moderate diarrhea (grade 2), her general condition improved. A PET-CT scan after 6 cycles of Nivolumab showed a morphologic and metabolic response of all lung and adrenal metastases, but an enlargement of several lymph nodes (retroclavicular, mediastinal and at both hili of the lungs) with intense FDG uptake. Moreover, a strong and diffuse FDG-activity was shown pleural, in the right lower lobe, in several bones and in the gut (Figure 1B).

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