Pseudoprogression presenting as intestinal perforation in non‑small cell lung cancer treated with anti‑PD‑1: A case report

Abstract

Pseudoprogression is not frequently observed in patients with non-small cell lung cancer (NSCLC) who are treated with immune checkpoint inhibitors. We report on a case of pseudoprogression, which was presented as intestinal perforation after pembrolizumab immunotherapy for NSCLC. A-54-year-old man with stage IV NSCLC received pembrolizumab therapy. The patient was admitted to our hospital because of acute abdominal pain and the computed tomography scan revealed diffuse wall thickening of the small bowel with free intraperitoneal air. Intestinal perforation was suspected and surgical resection was performed. Histological evaluation of the resected specimen showed infiltrated lymphocytes positive for CD3, CD8 with necrotic tumor cells, suggestive of an immune reaction. Although intestinal perforation after treatment with immune checkpoint inhibitors is rare, it can be an unusual presentation of pseudoprogression and clinicians should be aware of this possibility.

Squamous Cell Carcinoma of the Tonsil Causing Small Bowel Perforation in the Setting of Metastasis and Treatment With Programmed Death-1 Inhibitors: A Case Report

“…Here we describe a case of small bowel perforation attributed to a primary SCCHN metastasizing to the GIT in the setting of treatment with PD-1 inhibitors. This is the first reported case of a palatine tonsillar cancer metastasizing to the small bowel, and adds to the small number of reported bowel perforations resulting from treatment with monoclonal PD-1 and PD-L1 inhibitors in the presence of metastatic tumor from any primary source [10][11][12][13].…”

Impact of pseudoprogression and treatment beyond progression on outcome in patients with non-small cell lung cancer treated with immune checkpoint inhibitors

“…One case report demonstrated that cytotoxic T lymphocytes positive for CD3 and CD8 were infiltrated into the metastatic tumor in a patient who experienced PsP. 22 As T-lymphocyte infiltration in tumor and stroma has been reported as a promising prognostic factor in NSCLC patients, 23 the better outcome in PsP patients may in part be associated with the favorable effect of T-cell infiltration.…”

Two cases of rare late onset life-threatening pseudoprogression with immune check point inhibitors in advanced cancer patients – a case report

“…Pseudoprogression is an atypical pattern of response. In some cases, it could be associated with dramatic symptoms, such as tamponade and pleural effusions [6], intracranial hypertension [7], or bowel perforation [8]. As in our two cases, pseudoprogression may also be late-onset after ICI initiation [9,10].…”