Primary squamous cell carcinoma of the pleura treated with nivolumab

Our plain-English summary of Primary squamous cell carcinoma of the pleura treated with nivolumab, by I. Sigala, N. Alevizopoulos, K. Elefteriou, et al (Respirology Case Reports, 2020).

The study

• Authors: I. Sigala, N. Alevizopoulos, K. Elefteriou, N. Gianniou, I. Kalomenidis
• Journal: Respirology Case Reports
• Published: 2020;8(2):e00516
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural effusions usually manifest in the course of metastatic cancer disease. Primary pleural tumours are rare with mesothelioma being by far the most common. Primary squamous cell carcinoma of the pleura (PSCCP) is extremely rare. It is usually asymptomatic, until it invades the pleura presenting pain as the first symptom. Our knowledge about its treatment or prognosis is limited due to its rarity. We present the case of a 48-year-old man who presented with persistent right-sided thoracic pain with chest computed tomography (CT) scan demonstrating a right-sided pleural effusion and pleural mass invading the ribs. Ultrasound-guided biopsy revealed a PSCCP. Positron emission tomography staging demonstrated metastatic lung and lymph node involvement precluding surgical therapy. We provide information about treatment, including immunotherapy as well as extended follow-up course. Immunotherapy with nivolumab resulted in prolongation of survival with good quality of life.

© 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This case report from Athens, Greece, described a 48-year-old man, an active smoker, with primary squamous cell carcinoma of the pleura, a cancer the authors called extremely rare. The article does not mention asbestos. A chest CT scan showed fluid around the right lung and a 6.4-cm pleural mass invading the eighth and ninth ribs. A biopsy confirmed the diagnosis. The authors stated that the staining pattern (positive for p63 and p40) distinguished it from mesothelioma. A PET scan showed spread to two nodules in the left lung and to lymph nodes. Six cycles of cisplatin and docetaxel chemotherapy helped at first, but the disease had progressed by six months. The patient then received nivolumab, an immunotherapy drug, with radiation to the chest, and the disease stayed stable for 13 months. Later the patient developed a brain metastasis, faster tumour growth, severe lung inflammation caused by nivolumab, and tumour invasion of the spine pressing on the spinal cord. The patient died 24 months after diagnosis. The authors concluded that immunotherapy resulted in extremely prolonged disease control.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 48-year-old man, an active smoker, with persistent right-sided chest pain for more than a month. The authors are from Evaggelismos Hospital, Athens, Greece. No dates of care are given.
• Exposure: No asbestos or occupational exposure is reported. The patient was an active smoker. The treatments described were cisplatin plus docetaxel chemotherapy, then nivolumab at 3 mg/kg (240 mg every 15 days) with 50 Gy of stereotactic radiotherapy.
• Main results:
  • Chest CT showed a right-sided pleural effusion and a 6.4-cm pleural mass invading the eighth and ninth ribs, with smaller nodules over the pleura.
  • Ultrasound-guided biopsy showed primary squamous cell carcinoma of the pleura: p63+, CK5/6+, p40+, TTF-1 negative, wild-type EGFR, and less than 1% PD-L1 positivity.
  • The authors stated that positivity for both p63 and p40 distinguished the tumour from mesothelioma.
  • PET scan showed uptake in the pleural mass and nodules (SUVmax 32), in two pulmonary nodules in the left lung (SUVmax 4.5), and in right epiphrenic and subcarinal lymph nodes (SUVmax 8.7).
  • Six cycles of cisplatin and docetaxel gave a good initial response, but CT at the end of treatment (six months from diagnosis) showed disease progression.
  • On nivolumab with local radiotherapy, the disease remained stable for 13 months, with excellent quality of life.
  • Twenty months after diagnosis a solitary brain metastasis appeared. After this the tumour grew fast locally despite nivolumab.
  • Grade III pneumonitis due to nivolumab caused severe respiratory failure at 21 months from diagnosis (14th month of nivolumab). Nivolumab was permanently stopped.
  • The tumour invaded the T6 to T8 vertebrae and pressed on the spinal cord. After palliative surgery and comfort care, the patient died 24 months after initial diagnosis.
• The authors' conclusion: The authors concluded that immunotherapy with nivolumab resulted in extremely prolonged disease control in this patient. They stated that, to their knowledge, immunotherapy had not previously been given to patients with this cancer.

Topics

Medical terms in this study, explained in our Lexicon: Squamous Cell Carcinoma, Pleura, Nivolumab (Opdivo), Pleural Effusion, Mesothelioma, Prognosis, Ultrasound, Biopsy.

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