PMC6199376_01
CT imaging of patient treated with RT plus nivolumab. Excellent partial response at 2 months and near complete response at 6 months of the lesions in the left neck, supraclavicular region, lung apex, pleural, and axillar disease. Response was maintained for 13 months.
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F1
His disease continued to progress on PET/CT despite two additional cycles of gemcitabine plus docetaxel, as well as three cycles of ifosfamide (Figure 1). Follow-up CTs demonstrated a striking decrease in tumor burden at the left lateral neck mass, supraclavicular lymph nodes, left chest wall and left axilla over the next 13 months of nivolumab treatment (Figure 1).
CT imaging of patient with Stereotactic Body Radiation therapy (SBRT) plus ipilimumab and nivolumab. Resolution of right sided tracheoesophageal lymph node and enlarged node between the left common carotid and subclavian arteries. The patient had no new lesions and no measurable disease by RECIST criterion consistent with a complete response. Patient has remained in complete response with continued decrease in size of these lymph nodes as of most recent imaging 2 years after his initial treatment with palliative RT combined with nivolumab.
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F2
Five months after starting SBRT plus dual agent CBI, CT imaging of the neck showed resolution of the irradiated right tracheoesophageal groove lymph node (Figure 2) as well as the non-irradiated left clavicular node enlargement and no new or progressive lymphadenopathy or other masses.
Serum LDH of patient treated with RT plus nivolumab. Serum LDH decreased from 1,000 U/L at the beginning of therapy to 215 U/L at 4 months. Serum LDH has been maintained within normal limits (125-250 U/L) until present.
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F3
Additionally, serum lactate dehydrogenase (LDH), a prognostic factor and surrogate marker of disease burden, decreased from 1,000 U/L at the beginning of this therapy to 215 U/L (Figure 3).
Treatment timeline. Treatments and responses from diagnosis until present.
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F4
Tumors (RECIST) 1.1 5 months after initiation of ipilimumab plus nivolumab plus SBRT determined complete response. The patient remains in complete response at most recent imaging over 2 years since his initial treatment with radiation combined with nivolumab and he continues to do well clinically (Figure 4).