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CASE REPORT
Year : 2020  |  Volume : 16  |  Issue : 4  |  Page : 941-945

Long-term survival of a patient with programmed death ligand 1-negative lung adenocarcinoma and oligoprogressive disease treated with nivolumab and stereotactic body radiation therapy


1 Department of Medical Oncology, Hospital Universitario Infanta Cristina, Madrid, Spain
2 Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid, Spain

Correspondence Address:
Miguel J Sotelo
Department of Medical Oncology, Hospital Universitario Infanta Cristina, Avenida 9 de Junio, 228981 Parla, Madrid
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_81_19

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Immune-checkpoint inhibitors have shown to prolong survival in patients with metastatic non-small cell lung cancer. Programmed death ligand 1 (PD-L1) expression is associated with a higher probability of response, although some patients with PD-L1 negative tumors may also respond or show durable stabilizations. However, the optimal strategy after progression to immunotherapy (IO) is not yet defined. Patients with oligometastatic disease may benefit from local treatments such as radiotherapy (RT), achieving significant local control rates. In addition, RT is claimed to have numerous immunogenic effects that could synergize with IO. We present the case of a complete responder to nivolumab that after a monotopic adrenal relapse received stereotactic body radiation therapy, followed by maintenance nivolumab achieving a partial response that is still ongoing. Aspects such as mechanisms of acquired resistance to PD-L1 inhibitors, the optimal management after progression, and the potential interplay between IO and RT are briefly reviewed and discussed.


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