Follicular lymphoma generating in a patient with non-small cell lung cancer following nivolumab discontinuation

Abstract

Introduction Immune checkpoint inhibitors have demonstrated the benefit for many cancer types, melanoma, non-small cell lung cancer, urothelial cancer, renal cell cancer, etc. Especially in advanced non-small cell lung cancer, significant improvement in survival results has been shown. Case Report Here, we report a 66-year-old man with lung adenocarcinoma who received nivolumab for 80 cycles. Management and Outcome: Two months after discontinuing nivolumab, he developed follicular lymphoma. Pneumonitis was also accompanied, which was treated with metilprednisolon, but he died due to progressive respiratory failure. Discussion Our clinical knowledge with checkpoint inhibitors is increasing day by day, and to the best of our knowledge, this paper presents the first case in the English literature who developed follicular lymphoma after discontinuing nivolumab in non-small cell lung cancer patient.

Successful treatment of lung cancer coexisting with B‑cell lymphoma with pembrolizumab following rituximab‑included chemotherapy: A case report

“…However, the mechanisms underlying the development and exacerbation of B-cell lymphoma by ICI remain unclear. Two studies have reported the development of lymphoma after the cessation of ICI therapy ( 8 , 13 ) and one suggested that nivolumab treatment might inhibit the development of lymphoma ( 8 ) Moreover, the development of B-cell lymphoma after ICI treatment requires a long time. Previous studies have reported 80 cycles of treatment, 27 cycles of nivolumab, and approximately 2 years from pembrolizumab commencement ( 8 , 9 , 14 ) for the development of B-cell lymphoma, indicating that ICIs were not a direct cause of lymphoma development.…”

“…Two studies have reported the development of lymphoma after the cessation of ICI therapy ( 8 , 13 ) and one suggested that nivolumab treatment might inhibit the development of lymphoma ( 8 ) Moreover, the development of B-cell lymphoma after ICI treatment requires a long time. Previous studies have reported 80 cycles of treatment, 27 cycles of nivolumab, and approximately 2 years from pembrolizumab commencement ( 8 , 9 , 14 ) for the development of B-cell lymphoma, indicating that ICIs were not a direct cause of lymphoma development. However, the development and exacerbation of lymphoma during one case of pembrolizumab treatment suggested that the mechanism of exacerbation might be the depression of follicular helper T-cells and follicular regulatory T-cells induced by anti-PD-1( 3 ).…”

“…Moreover, the safety of ICIs in B-cell lymphoma has yet not been clarified. Some studies have reported the development of malignant lymphomas, such as FL, during or after treatment with ICIs ( 3 , 8 , 9 ); one study suspected that the development of lymphoma might be caused by ICIs ( 3 ). Thus, consensus on the commencement of ICI treatment for patients with advanced lung cancer in conjunction with B-cell lymphomas is not unanimous because of fear of lymphoma progression.…”