A 61-year-old woman with lung adenocarcinoma failed first-line treatment and was placed on immunotherapy with nivolumab. FDG-PET/CT before immunotherapy showed metastases to thoracic nodes, liver, adrenal gland, and skeleton. Seven weeks after starting nivolumab, FDG-PET/CT showed mild residual activity in thoracic nodes and otherwise complete response. After 15 weeks, enlarged and FDG-avid axillary lymphadenopathy and worsening supraclavicular lymphadenopathy developed. After 20 weeks, FDG-PET/CT demonstrated marked improvement of axillary and supraclavicular lymphadenopathy. This case demonstrates that later progression of disease can still respond to continuing immunotherapy, hypothetically because of dynamic adaptations in the tug-of-war between the immunotherapy-augmented immune system and tumor.
From the *Departments of Medical Imaging and †Medicine, Banner University Medical Center; and ‡Department of Biomedical Engineering, University of Arizona, Tucson, AZ.
Received for publication October 10, 2017; revision accepted November 13, 2017.
Conflict of interest and sources of funding: none declared.
Correspondence to: Naghmehossadat Eshghi, MD, PhD, Department of Medical Imaging, Banner University Medical Center, 1501 N. Campbell Avenue, PO Box 245067, Tucson, AZ. E-mail: firstname.lastname@example.org.