PD-L1 –100% : A rare entity · Dr Sanju Cyriac–Medical Oncologist, RajagiriHospital, India...

ESMO Preceptorship Programme

PD-L1 – 100% : A rare entity

Dr Sanju Cyriac – Medical Oncologist, Rajagiri Hospital, India

Immuno-oncology– Singapore – 26-27 November 2018

ESMO PRECEPTORSHIP PROGRAMME

� Disclosures: Nil


� 64 year old male presented with multiple neck nodes

� Chronic smoker

� Clinically multiple level II- V hard LN palpable

� CT neck and chest: Multiple cervical and mediastinalLN along with right hilar lesion

� Cervical LN biopsy – Adenocarcinoma

� IHC – CK 7+, CK 20 -, TTF +

� PET CT – Multiple cervical and mediastinal lymph nodes, right hilar LN


� EGFR/ALK mutations: negative


� Initiated on Pemetrexed carboplatin

� After 4 cycles – clinicoradiologically excellent

response

� Unfortunately after 4th maintenance Pemetrexed, he

had progression

� He was offered Docetexal vs Nivolumab

� PDL 1 was requested on the initial specimen


� While PDL1 results were awaited, he had rather rapid progression

� He was initiated on Nivolumab

� After first cycle, he was admitted with unexplained dyspnoea

� CT chest: no new findings


� He was found to be in CR after the 2nd cycle

� Presently he is in Q monthly Nivolumab 240 mg – completed 12 months

� He has left axillary LN, FNA proven adenocarcinoma as the only site of disease

� This lesion regresses after each dose of Nivolumab

� He had hyperthyroidism and later hypothyroidism and is on Thyroid hormone replacement


Questions

� How frequent is PDL1- 100% positive??

� This patient had rather rapid progression but still responded well to Nivolumab - !!!

� I f we give Nivolumab Q montly why not Q 2 monthly??

� What is the optimal dose of Nivolumab? Will low dose Nivolumab work ?

ESMO Preceptorship Programme

PD-L1 –100% : A rare entity · Dr Sanju Cyriac–Medical Oncologist, RajagiriHospital, India...

Documents

Transcript of PD-L1 –100% : A rare entity · Dr Sanju Cyriac–Medical Oncologist, RajagiriHospital, India...