A 64-year-old man with a history of asbestos exposure was diagnosed with stage IIIB epithelioid malignant pleural mesothelioma. After chemotherapy was introduced, the size of the tumors decreased initially but subsequently increased. A total of 13 sessions of palliative radiotherapy were conducted for multiple ectopic pleural masses and celiac lymph node metastases over five years and 11 months. The patient received 8 courses of nivolumab, which became available after he completed radiotherapy. Nevertheless, he had progressive disease and died seven years and 11 months after the initial examination. We report this instructive case of long-term survival achieved by repeated palliative radiotherapy.
Pembrolizumab, a treatment for advanced cancers, can cause immune-related adverse events (irAEs), and among these, esophagitis is rare. We report on an 80-year-old man with squamous cell lung carcinoma who started treatment with pembrolizumab at 200 mg every three weeks. After the first administration, the patient developed odynophagia. Esomeprazole did not improve symptoms, and upper gastrointestinal endoscopy and biopsy revealed esophagitis dissecans superficialis, which was considered as an irAE. Oral prednisolone was started, and odynophagia rapidly improved and the mucosal lesions healed. However, steroid withdrawal was unsuccessful because of repeated relapses. When patients on immune checkpoint inhibitors develop dysphagia, esophagitis should be suspected as an irAE.
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