PMC6333318_01
Treatment intervention process and imaging of disease progress after PD-L1 blockade.. Notes: (A) Summary of interventions received by the present patient. Arrowheads indicate time points for each intervention. (B) PET/CT or CT images for metastatic lesions before and after PD-L1 blockade.. Abbreviations: PET, positron emission tomography; CT, computer tomography; PD-L1, programmed cell death ligand-1; IHC, immunohistochemistry; NGS, next-generation sequencing.
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Twelve months after the RC, follow-up chest radiography and computer tomography (CT) revealed metastases in the right lumbar muscles, left adrenal gland, and lungs (Figure 1). Chest radiography and a full-body CT on January 15, 2018 showed pronounced enlargement of a left lung metastasis (1,004% increase from preimmunotherapy size) and progression of the right lumbar muscle and left adrenal gland metastases, as well as new multiple lymph node metastases involving a mediastinal, a left supraclavicular, and two hilar lymph nodes (Figure 1). One month after the patient began cisplatin/gemcitabine chemotherapy, we observed drastic reductions in lesion size (Figure 1).
Tumor metastasis changes over time. The 0-month time point represents the start of PD-L1 blockade treatment.. Abbreviation: PD-L1, programmed cell death ligand-1.
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Comparing the TGR for the 8-week period following ICB to that for the 1-week period prior to ICB, we determined that the patient had a TGR ratio of 4.0, reflecting a fourfold increase in growth rate in association with ICB onset, meeting the criteria for hyperprogression (Figure 2).
Anti-PD-L1 immunohistochemistry of bladder cancer tissues.. Notes: (A) H&E stained tumor section with 40% tumor cell proportion. (B) Image of IHC PD-L1 labeled section subjected to PD-L1 percentage scoring. The percentages of tumor cells and tumor-infiltrating immune cells are 15%-25% and 5%-10%, respectively.. Abbreviations: PD-L1, programmed cell death ligand-1; IHC, immunohistochemistry.
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PD-L1 expression. In the H&E-stained sections (Figure 3A), we observed a 40% tumor cell ratio; >100 PD-L1 immunopositive tumor cells were examined under a light microscope. PD-L1 staining was localized primarily to cell membranes, with some non-specific cytoplasm staining. We found that 15%-25% and 5%-10% of tumor cells and tumor-infiltrating immune cells, respectively, showed PD-L1 immunopositivity (Figure 3B).