AT LAST! It was not a progression!

Raquel Paulinetti Camara; Kelly Lopes; Miguel Barbosa; Inês Sucena; Carla Simão; Paulo Mota; Dina Matias; Telma Sequeira; Teresa Almodovar

doi:10.32932/gecp.2022.09.026

Authors

Raquel Paulinetti Camara Pulmonology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Pulmonology Department, Hospital Nossa Senhora do Rosário – Centro Hospitalar Barreiro -Montijo, Barreiro, Portugal https://orcid.org/0000-0001-7281-0406
Kelly Lopes Pulmonology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Pulmonology Department, Hospital Nossa Senhora do Rosário – Centro Hospitalar Barreiro -Montijo, Barreiro, Portugal https://orcid.org/0000-0002-0803-5916
Miguel Barbosa Pulmonology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal https://orcid.org/0000-0001-6723-7027
Inês Sucena Pulmonology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal https://orcid.org/0000-0002-6610-3008
Carla Simão Pulmonology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal https://orcid.org/0000-0003-1470-5733
Paulo Mota Pulmonology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal https://orcid.org/0000-0001-6660-1448
Dina Matias Pulmonology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal https://orcid.org/0000-0002-5619-353X
Telma Sequeira Pulmonology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal https://orcid.org/0000-0001-8031-7136
Teresa Almodovar Pulmonology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal https://orcid.org/0000-0001-8950-2100

DOI:

https://doi.org/10.32932/gecp.2022.09.026

Keywords:

adenocarcinoma, hypophysitis, nivolumab

Abstract

Introduction: Nivolumab is approved in Portugal for non-small cell metastatic lung cancer, as one of the indications, after progressing on chemotherapy. As an immune checkpoint inhibitor (ICI) immune-related adverse events (irAE) are possible reactions.
Case report: A 64-year-old man with stage III lung adenocarcinoma who progressed after chemoradiotherapy and first line metastatic chemotherapy started nivolumab. Approximately 16 months after starting treatment he is admitted to the hospital with suspected brain metastasis due to vomiting, prostration and altered mental state. Brain-CT showed no abnormalities, but analyses showed decreased levels of ACTH and cortisol, which supported the diagnosis of hypophysitis. Nivolumab was stopped and high-dose hydrocortisone was initiated with good response. After discharge, patient showed disease stability and maintained vigilance.
Discussion: Hypophysitis is an uncommon endocrine irAE of nivolumab. It appears on average 6 months after starting treatment and shows nonspecific symptoms often misjudged as disease progression. Only a high degree of suspicion can lead to appropriate investigation and treatment.

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References

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AT LAST! It was not a progression!

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