The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Pneumocystis Pneumonia Developing during Treatment of Recurrent Renal Cell Cancer with Nivolumab

니볼루맙 치료 도중 발생한 폐포자충 폐렴 1예

  • Kim, Hak Ro (Division of Hematology and Oncology, Department of Internal Medicine, Pohang Semyeong Christianity Hospital) ;
  • Keam, Bhumsuk (Department of Internal Medicine, Seoul National University Hospital) ;
  • Park, Young Sik (Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Miso (Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Tae Min (Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Dong-Wan (Department of Internal Medicine, Seoul National University Hospital) ;
  • Heo, Dae Seog (Department of Internal Medicine, Seoul National University Hospital)
  • Received : 2017.12.01
  • Accepted : 2018.02.21
  • Published : 2018.12.01
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Abstract

Nivolumab is an immune checkpoint inhibitor approved for the treatment of metastatic cancers. Here, we report the case of a 65-year-old male with recurrent renal cell carcinoma. After six cycles of nivolumab treatment, positron emission tomography/computed tomography (PET/CT) was performed to evaluate the response. PET/CT revealed diffuse ground glass opacities in both lungs. He developed a cough, sputum, chills, and a febrile sense. After bronchoscopic bronchoalveolar lavage, pneumocystis pneumonia was finally diagnosed.

니볼루맙을 사용하는 도중 폐렴이 발생할 수 있고, 폐렴이 의심되면 치료하기 이전에 바이러스를 포함한 감염 여부와 림프관성 암의 진행 상태 및 울혈성 심장 기능 상실 여부 등의 감별이 필요하며 폐렴의 등급과 중증도를 평가하여 스테로이드를 경험적으로 쓰는 것이 중요하다. 본 증례에서는 감염을 배제하기 위하여 기관지 폐포세척을 시행한 후 폐포자충 폐렴이 진단된 사례로 드물기는 하지만 페포자충 폐렴의 감별이 필요함을 보여주어 증례로 보고하는 바이다.

Keywords

References

  1. Okazaki T, Chikuma S, Iwai Y, Fagarasan S, Honjo T. A rheostat for immune responses: the unique properties of PD-1 and their advantages for clinical application. Nat Immunol 2013;14:1212-1218. https://doi.org/10.1038/ni.2762
  2. Nishino M, Giobbie-Hurder A, Hatabu H, Ramaiya NH, Hodi FS. Incidence of programmed cell death 1 inhibitor-related pneumonitis in patients with advanced cancer: a systematic review and meta-analysis. JAMA Oncol 2016;2:1607-1616. https://doi.org/10.1001/jamaoncol.2016.2453
  3. Naidoo, Wang X, Woo KM, et al. Pneumonitis in patients treated with anti-programmed death-1/programmed death ligand 1 therapy. J Clin Oncol 2017;35:709-717. https://doi.org/10.1200/JCO.2016.68.2005
  4. Topalian SL, Hodi FS, Brahmer JR, et al. Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med 2012;366:2443-2454. https://doi.org/10.1056/NEJMoa1200690
  5. Robert C, Long GV, Brady B, et al. Nivolumab in previously untreated melanoma without BRAF mutation. N Engl J Med 2015;372:320-330. https://doi.org/10.1056/NEJMoa1412082
  6. Nishino M, Sholl LM, Hodi FS, Hatabu H, Ramaiya NH. Anti-PD-1-related pneumonitis during cancer immunotherapy. N Engl J Med 2015;373:288-290. https://doi.org/10.1056/NEJMc1505197
  7. Chiou VL, Burotto M. Pseudoprogression and immune-related response in solid tumors. J Clin Oncol 2015;33:3541-3543. https://doi.org/10.1200/JCO.2015.61.6870
  8. Thomas CF Jr, Limper AH. Pneumocystis pneumonia. N Engl J Med 2004;350:2487-2498. https://doi.org/10.1056/NEJMra032588
  9. Rizvi NA, Mazieres J, Planchard D, et al. Activity and safety of nivolumab, an anti-PD-1 immune checkpoint inhibitor, for patients with advanced, refractory squamous non-small-cell lung cancer (CheckMate 063): a phase 2, single-arm trial. Lancet Oncol 2015;16:257-265. https://doi.org/10.1016/S1470-2045(15)70054-9
  10. Muhlethaler K, Bogli-Stuber K, Wasmer S, et al. Quantitative PCR to diagnose pneumocystis pneumonia in immunocompromised non-HIV patients. Eur Respir J 2012;39:971-978. https://doi.org/10.1183/09031936.00095811