Radiation Recall Pneumonitis in A Patient Treated by Nivolumab for Non-Small Cell Lung Cancer, No Relapse with Rechallenge

Introduction: Radiation Recall Pneumonitis (RRP) is an inflammatory phenomenon occurring in a previously irradiated area of the lungs in response to precipitating agents. The diagnosis is based on clinical features such fever, dyspnea, dry cough, asthenia, and radiologic abnormalities (ground-glass opacities and condensations) in the irradiated field and must occur after the administration of an inciting agent. We reported a case of RRP induced by nivolumab.

Report: A 58 year old woman previously treated by left mastectomy and adjuvant radiotherapy for a breast cancer (October 2016) was diagnosed with a right lung adenocarcinoma in December 2016. Concomitant radio-chemotherapy with irradiation of the upper part of the right hemithorax was performed from February to March 2017. Unfortunately, a new metastasis appeared in April 2017. A new line of treatment with nivolumab was started. Four weeks after the onset of the checkpoint inhibitor, she presented clinical and imaging criteria evoking the diagnosis of RRP induced by nivolumab. A high dose systemic steroid was introduced. As a result, general state, respiratory conditions and imaging features were improved.

Conclusion: Some drugs are known to be associated with RRP, mainly traditional chemotherapies. Patients generally improved their condition after a break of the precipitating agent and with steroids. RRP induced by nivolumab has only been described once in a Japanese case report. It constitutes the first report of such a case in Europe. In our case, nivolumab was reintroduced after the resolution of the RRP. After 22 new cycles of treatment we didn’t observe recurrence of RRP.

Author(s): Pierre Thoré1*, Benoît Godbert2, Isabelle Petit3 and Ari Chaouat1,4

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