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━━ Background. Nivolumab, an immune checkpoint inhibitor, is effective for previously treated advanced non-small cell lung cancer. However, drug-induced interstitial pneumonia in nivolumab has been reported in some cases, requiring immediate management. Case. A 67-year-old woman received adjuvant chemotherapy for adenosquamous carcinoma of the lung. After six months, computed tomography (CT) revealed multiple metastases involving the bilateral lung, right kidney, and accessory nerve lymph node. Nivolumab was started and achieved a partial response. After seven cycles of treatment, CT showed multiple patchy infiltrative shadows in the bilateral subpleural areas. According to the clinical course and imaging findings, drug-induced organizing pneumonia due to nivolumab was suspected, and 30 mg/day of prednisolone was administered after discontinuing nivolumab, which promptly improved the pneumonia. Conclusion. The immediate administration of steroids is important for cases that develop drug-induced organizing pneumonia during treatment with nivolumab. (JJLC. 2019;59:53-59) KEY WORDS━━ Adenosquamous carcinoma of the lung, Nivolumab, Drug-induced interstitial pneumonia, AntiPD-1 antibody Corresponding author: Yoshitaka Zenke. Received June 18, 2018; accepted November 8, 2018. 要旨━━背景.免疫チェックポイント阻害薬であるニ ボルマブは,既治療進行非小細胞肺癌に対して有効性が 認められている.一方,副作用に間質性肺炎を認めるこ とがあり,早期の薬剤性肺炎の対策が重要である.症例. 67歳,非喫煙の女性.肺腺扁平上皮癌に対して術後補助 化学療法施行.6ヶ月後に多発肺転移,右腎転移,副神経 リンパ節転移を認め,ニボルマブを開始し,部分奏効の 腫瘍縮小効果を認めた.7サイクル施行後に両側胸膜下 主体の斑状多発浸潤影を認め,臨床経過と画像所見より ニボルマブによる器質化肺炎型の薬剤性間質性肺炎を強 く疑い,同薬剤中止のうえプレドニゾロン 30 mg/日を開 始し,速やかに肺炎は改善した.結論.ニボルマブ使用 において器質化肺炎型の薬剤性間質性肺炎を発症した場 合は,早期のステロイドによる治療が重要である. 索引用語━━肺腺扁平上皮癌,ニボルマブ,薬剤性間質 性肺炎,抗 PD-1抗体 1がん・感染症センター都立駒込病院呼吸器内科;2国立がん研 究センター東病院呼吸器内科;3がん・感染症センター都立駒込病 院病理科. 論文責任者:善家義貴. 受付日:2018年 6月 18日,採択日:2018年 11月 8日. (肺癌.2019;59:53-59) 2019 The Japan Lung Cancer Society Nivolumab-related Pneumonitis in a Patient with Lung Adenosquamous Carcinoma―Kitadai et al 54 Japanese Journal of Lung Cancer―Vol 59, No 1, Feb 20, 2019―www.haigan.gr.jp Figure 1. Microscopic findings of adenosquamous carcinoma of the lung (A) and immunostaining of cytokeratin 5/6 (D). The adenocarcinoma (B) and squamous cell carcinoma components (C). PD-L1 IHC testing in adenocarcinoma (E) and squamous cell carcinoma (F). A

A Case of Lung Adenosquamous Carcinoma with Drug-induced Organizing Pneumonia due to Nivolumab After Achieving a Clinical Response