PMC5118772_01
CT scan images demonstrate a decrease in size of surgical site nodules, inferior vena cava tumor thrombus, paraaortic lymph node metastasis, and lung nodules after eight and fifteen infusions of nivolumab. (A) Before nivolumab therapy initiation. (B) After eight infusions of nivolumab. (C) After fifteen infusions of nivolumab.
fonc-06-00250-g001.jpg
PMC5118772_01_fonc-06-00250-g001.jpg
F1
Nine months after resection, he developed lung and paraaortic lymph node metastasis and the disease reappeared in the surgical site and the inferior vena cava tumor thrombus increased in size (Figure 1A). After eight infusions of nivolumab, a computed tomography (CT) scan showed a partial response at thoracic and abdominal levels (Figure 1B). At present, the patient continues with the treatment, there have been no new immune-related adverse events, and the last CT scan has shown a durable partial response (Figure 1C) after 15 infusions of treatment.
Levels of serum creatinine rose 2 weeks after the fifth infusion of nivolumab. Nivolumab therapy was discontinued and immediately prednisone treatment was initiated. Serum creatine levels diminished and nivolumab could be restarted.
fonc-06-00250-g002.jpg
PMC5118772_01_fonc-06-00250-g002.jpg
F2
At that moment, after having ruled out obstruction and prerenal causes, we discontinued the nivolumab therapy and immediately started treatment with prednisone at 1 mg/kg every day and 3 days later, when the acute renal failure improved to grade 1, we initiated a progressive decrease of the corticosteroids dose (Figure 2).