PMC5228676_01
In patient 1, a 54-year-old man with advanced melanoma received a trial of anti-PD-1 treatment with pembrolizumab combined with radiotherapy. Before anti-PD-1 treatment, chest radiograph (CXR) and computed tomography (CT) revealed pulmonary lesions over bilateral hilums (A and B). After 4 cycles of anti-PD-1 treatment, the findings significantly progressed and air-bronchograms at right lower lobe with obstructive pneumonitis was found (C and D). CT = computed tomography, CXR = chest radiograph, PD-1 = programmed cell death protein 1.
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F1
May 24, 2014. Metastatic lymphadenopathy over right anterior neck and newly developed lung lesions (Fig. 1A and B) were still noted 10 months later. However, hemoptysis was developed after 4th cycle of anti-PD-1 treatment and chest computed tomography (CT) showed air-bronchograms at right lower lobe with obstructive pneumonitis (Fig. 1C and D).
PMC5228676_02
In patient 2, a 57-year-old man with invasive thymoma received photodynamic therapy (PDT) for pulmonary, pleural lesions and followed by the self-paid concurrent treatment with ipilimumab and nivolumab every 3 weeks due to the progressive disease. Before the concurrent immunotherapy, chest radiograph (CXR) and computed tomography (CT) revealed consolidation at right upper, lower lungs, pleural seeding, and lung-to-lung metastasis (A and B). Three months later, the findings significantly progressed and involved all lobes, with decreased lung volumes and pleural effusion (C and D). CT = computed tomography, CXR = chest radiograph, PD-1 = programmed cell death protein 1, PDT = photodynamic therapy.
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F2
September 2013. Slowly progressive disease (Fig. 2A and B) was still noted in following 1 year and he began to receive the self-paid immunotherapy of ipilizumab combined with chemotherapy from November 2014. Chest radiograph (CXR) and CT revealed newly developed consolidative lesions in both lungs and fibrosis or pneumonitis was considered (Fig. 2C and D).
PMC5228676_03
In patient 3, a 79-year-old man with advanced proximal jejunal cancer underwent primary lesions resection and received proton therapy over pulmonary metastatic lesions, followed by the self-paid anti-PD-1 treatment. Before anti-PD-1 treatment, pulmonary metastatic lesions over bilateral hilums were found (A and B). After 4 cycles of treatment, the findings showed multilobular opacities over both lower lungs (C and D). PD-1 = programmed cell death protein 1.
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F3
Elevated tumor markers were detected (improvement of pulmonary lesions, Fig. 3A and B) and the self-paid salvage immunotherapy with pembrolizumab (2 mg/kg, anti-PD-1 regimen) every 3 weeks was prescribed to him from December 16th, 2014. CXR showed consolidative patch at right lower lung (Fig. 3C) and abdominal CT revealed intestinal obstruction of distal jejunum, multilobular opacities over both lower lungs (Fig. 3D).