BackgroundTumor debulking surgery followed by adjuvant chemotherapy or radiotherapy is a standard treatment for many solid malignancies. Although this approach can be effective, it often has limited success against recurrent or metastatic cancers and new multimodality approaches are needed. Adjuvant immunotherapy is another potentially effective approach. We therefore tested the efficacy of the TLR7 agonist imiquimod (IMQ) combined with agonistic anti-CD40 in an incomplete debulking model of malignant mesothelioma.MethodsEstablished subcutaneous murine ABA-HA mesothelioma tumors in BALB/c mice were surgically debulked by 75% and treated with either: i) saline; ii) intratumoral IMQ; iii) systemic anti-CD40 antibody, or using a combination of IMQ and anti-CD40. Tumour growth and survival were monitored, and the role of anti-tumor CD4 and CD8 T cells in therapeutic responses was determined.ResultsThe combination therapy of partial debulking surgery, IMQ and anti-CD40 significantly delayed tumor growth in a CD8 T cell dependent manner, and promoted tumor regression in 25% of animals with establishment of immunological memory. This response was associated with an increase in ICOS+ CD8 T cells and tumor-specific CTL activity in tumor draining lymph nodes along with an increase in ICOS+ CD8 T cells in responding tumours.ConclusionsWe show that the post-surgical environment can be significantly altered by the co-administration of adjuvant IMQ and anti-CD40, resulting in strong, systemic anti-tumor activity. Both adjuvants are available for clinical use/trial, hence this treatment regimen has clear translational potential.

Background: Pneumonia can easily mimic malignancies. Pulmonary nodule finding raise concern for lung cancer. A single lung opacity less than 3 centimetres in diameter is referred to as a solitary pulmonary nodule (SPN). These nodules sometimes incidentally discovered during routine computed tomography (CT) scan of the chest in relatively asymptomatic patients. We present unusual case of pneumonia like mass with spontaneous resolution.Case: Woman, 38-year-old, with solitary pulmonary nodule which was found accidentally in the left lung upper lobe, without any respiratory symptoms in June 2021. In August 2021, a chest CT scan was done for evaluating and the solitary nodule of the left lung upper lobe had resolved spontaneously without any treatment. The patient was prepared for diagnostic bronchoscopy at Persahabatan Hospital with the findings of normal bronchi and the branches. A bronchial washing was performed on the left B1+2 segment and cytology, fungal, microorganism and molecular tuberculosis examination were performed.Discussion: Pulmonary solitary nodule in left lung upper lobe in the beginning and spontaneous resolution after 2 months evaluation without any specific treatment, consider period of pneumonia. Whenever a patient is found to have an SPN, it is essential to determine the patient’s risk for malignancy. It is important to consider any pulmonary nodule to be malignant or not, and how it presents on CT Imaging.Conclusion: Pulmonary nodule may be found during pneumonia and may resolve spontaneously. The possibility of malignancy must still be considered. Awareness of condition from the history is important to help reassure patient about the disease even before diagnostic procedure was made.