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Diagnosis of Nivolumab-Induced Pneumonitis With PET Scan
Diffuse Lung Disease SESSION TITLE: Fellow Case Report Poster - Diffuse Lung Disease I SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM
Diagnosis of Nivolumab-Induced Pneumonitis With PET Scan Tapan Pandya MD* Raminderjit Sekhon MD Zeron Ghazarian MD Michael Hanna MD; and Medhat Ismail MD New York Medical College/St. Joseph’s Regional Medical Center, Paterson, NJ INTRODUCTION: Nivolumab is a monoclonal antibody to programmed cell death (PD-1) receptor approved for the treatment of patients with advanced Non Small Cell Lung Cancer (NSCLC) who experience progression of disease on or after standard chemotherapy. Pneumonitis is one of the side effect of Nivolumab. CASE PRESENTATION: A 71-year-old woman with Stage 3A Adenocarcinoma of the Lung, ex-smoker and COPD, received chemotherapy, had left upper lobectomy in July 2014. Patient had a PET scan in October 2015 which showed hypermetabolic uptake suggestive of recurrent tumor in the left upper lobe and left hilum with worsening subcarinal and mediastinal lymphadenopathy. The patient received total of 6 cycles of Nivolumab by February 2016. This patient presented to ER in March 2016 with shortness of breath for 3 weeks, low-grade fever and cough. She was hypoxic with oxygen saturation of 82% on room air with diffuse rales and rhonchi. CT chest showed new diffuse reticulonodular infiltrates. The patient had a PET scan 3 days prior to admission that showed diffuse, new hypermetabolic infiltrates bilaterally, where as previously seen hilar mass had resolved with improved subcarinal lymphadenopathy. The patient was admitted to the hospital and treated with IV steroids for Pneumonitis with improvement of symptoms and oxygenation.
CONCLUSIONS: Nivolumab can cause Pneumonitis in about 5% of patients. PET scan can be a very useful tool in evaluating development of Pneumonitis in patients receving Nivolumab and other anti-PD-1 receptor antibodies. Reference #1: Cancer Immunology Miniatures: Anti-PD-1 inhibitor-related pneumonitis in non- small cell lung cancer. Nishino M et al. PMID: 26865455 Reference #2: Overall Survival and Long-Term Safety of Nivolumab in Patients With Previously Treated Advanced Non-SmallCell Lung Cancer. Gettinger, S et al. PMID: 25897158 DISCLOSURE: The following authors have nothing to disclose: Tapan Pandya, Raminderjit Sekhon, Zeron Ghazarian, Michael Hanna, Medhat Ismail No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.509
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
495A
DIFFUSE LUNG DISEASE
DISCUSSION: Nivolumab, one of the anti-PD-1 receptor antibody, has shown durable responses and encouraging survival rates in patients with NSCLC who have received conventional chemotherapy in the past. One of the side effects of Nivolumab is Pneumonitis that is seen in about 5% cases. Chest X-ray and CT scans are used for diagnosis of Pneumonitis. The most effective treatment is avoiding offending drugs along with Oxygen and systemic steroids. In our case, the current PET scan showed significant hypermetabolic uptake in both lungs which is new comprared to the previous PET scan. The only different treatment between two PET scans is Nivolumab concluding that the Pneumonitis is most likely induced by Nivolumab.
Diagnosis of Nivolumab-Induced Pneumonitis With PET Scan Tapan Pandya MD* Raminderjit Sekhon MD Zeron Ghazarian MD Michael Hanna MD; and Medhat Ismail MD New York Medical College/St. Joseph’s Regional Medical Center, Paterson, NJ INTRODUCTION: Nivolumab is a monoclonal antibody to programmed cell death (PD-1) receptor approved for the treatment of patients with advanced Non Small Cell Lung Cancer (NSCLC) who experience progression of disease on or after standard chemotherapy. Pneumonitis is one of the side effect of Nivolumab. CASE PRESENTATION: A 71-year-old woman with Stage 3A Adenocarcinoma of the Lung, ex-smoker and COPD, received chemotherapy, had left upper lobectomy in July 2014. Patient had a PET scan in October 2015 which showed hypermetabolic uptake suggestive of recurrent tumor in the left upper lobe and left hilum with worsening subcarinal and mediastinal lymphadenopathy. The patient received total of 6 cycles of Nivolumab by February 2016. This patient presented to ER in March 2016 with shortness of breath for 3 weeks, low-grade fever and cough. She was hypoxic with oxygen saturation of 82% on room air with diffuse rales and rhonchi. CT chest showed new diffuse reticulonodular infiltrates. The patient had a PET scan 3 days prior to admission that showed diffuse, new hypermetabolic infiltrates bilaterally, where as previously seen hilar mass had resolved with improved subcarinal lymphadenopathy. The patient was admitted to the hospital and treated with IV steroids for Pneumonitis with improvement of symptoms and oxygenation.
CONCLUSIONS: Nivolumab can cause Pneumonitis in about 5% of patients. PET scan can be a very useful tool in evaluating development of Pneumonitis in patients receving Nivolumab and other anti-PD-1 receptor antibodies. Reference #1: Cancer Immunology Miniatures: Anti-PD-1 inhibitor-related pneumonitis in non- small cell lung cancer. Nishino M et al. PMID: 26865455 Reference #2: Overall Survival and Long-Term Safety of Nivolumab in Patients With Previously Treated Advanced Non-SmallCell Lung Cancer. Gettinger, S et al. PMID: 25897158 DISCLOSURE: The following authors have nothing to disclose: Tapan Pandya, Raminderjit Sekhon, Zeron Ghazarian, Michael Hanna, Medhat Ismail No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.509
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
495A
DIFFUSE LUNG DISEASE
DISCUSSION: Nivolumab, one of the anti-PD-1 receptor antibody, has shown durable responses and encouraging survival rates in patients with NSCLC who have received conventional chemotherapy in the past. One of the side effects of Nivolumab is Pneumonitis that is seen in about 5% cases. Chest X-ray and CT scans are used for diagnosis of Pneumonitis. The most effective treatment is avoiding offending drugs along with Oxygen and systemic steroids. In our case, the current PET scan showed significant hypermetabolic uptake in both lungs which is new comprared to the previous PET scan. The only different treatment between two PET scans is Nivolumab concluding that the Pneumonitis is most likely induced by Nivolumab.