Advances in immunotherapy have changed the therapeutic landscape of non-small cell lung cancer (NSCLC), extending overall survival over standard chemotherapy. However, by removing the protection against autoimmunity, immunotherapy can increase immune-related adverse events (irAEs). In addition, new patterns of radiological response have been observed in patients treated with immune checkpoint inhibitors (ICIs). We report the case of a 77 year-old patient with advanced lung adenocarcinoma, who presented three consecutive different irAEs (nephritis, hepatitis, and pneumonitis) and an atypical radiological response (partial response, dissociated response, and “disease flare”) in relation to treatment with the PD-1 inhibitor nivolumab. The role of ICIs in elderly patients, the incidence of consecutive irAEs, and the new patterns of radiological response, are also reviewed.

Immune checkpoint inhibitors (ICIs) represent a new standard of care for patients with advanced nonsmall cell lung cancer, improving overall survival compared with standard chemotherapy. However, a new pattern of response to ICIs characterized by accelerated tumor growth has been recently described, termed hyperprogressive disease (HPD). We report the case of a 73-year-old patient with advanced lung adenocarcinoma who developed HPD following treatment with a unique dose of atezolizumab for a skin metastasis that was refractory to chemotherapy and radiotherapy. Potential clinical biomarkers related to HPD to ICIs are reviewed.

months (p = 0,013). There were no significant differences in age, ECOG PS, histology, size, therapies or treatment line. Conclusions: The NLR remains a prognostic factor in both diseases, with or without EGFR mutation, but appear to have less impact on the outcome of EGFR mutated patients. In NSCLC EGFR mutated maybe inflammatory index could have implications on therapeutic choice, especially subsequent lines and his role deserves further study. Legal entity responsible for the study: Mario Scartozzi. Funding: Has not received any funding.

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