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ESMO Preceptorship Programme
PD-L1 – 100% : A rare entity
Dr Sanju Cyriac – Medical Oncologist, Rajagiri Hospital, India
Immuno-oncology– Singapore – 26-27 November 2018
ESMO PRECEPTORSHIP PROGRAMME
� Disclosures: Nil
ESMO PRECEPTORSHIP PROGRAMME
� 64 year old male presented with multiple neck nodes
� Chronic smoker
� Clinically multiple level II- V hard LN palpable
� CT neck and chest: Multiple cervical and mediastinalLN along with right hilar lesion
� Cervical LN biopsy – Adenocarcinoma
� IHC – CK 7+, CK 20 -, TTF +
� PET CT – Multiple cervical and mediastinal lymph nodes, right hilar LN
ESMO PRECEPTORSHIP PROGRAMME
ESMO PRECEPTORSHIP PROGRAMME
� EGFR/ALK mutations: negative
ESMO PRECEPTORSHIP PROGRAMME
� Initiated on Pemetrexed carboplatin
� After 4 cycles – clinicoradiologically excellent
response
� Unfortunately after 4th maintenance Pemetrexed, he
had progression
� He was offered Docetexal vs Nivolumab
� PDL 1 was requested on the initial specimen
ESMO PRECEPTORSHIP PROGRAMME
ESMO PRECEPTORSHIP PROGRAMME
� While PDL1 results were awaited, he had rather rapid progression
� He was initiated on Nivolumab
� After first cycle, he was admitted with unexplained dyspnoea
� CT chest: no new findings
ESMO PRECEPTORSHIP PROGRAMME
ESMO PRECEPTORSHIP PROGRAMME
� He was found to be in CR after the 2nd cycle
� Presently he is in Q monthly Nivolumab 240 mg – completed 12 months
� He has left axillary LN, FNA proven adenocarcinoma as the only site of disease
� This lesion regresses after each dose of Nivolumab
� He had hyperthyroidism and later hypothyroidism and is on Thyroid hormone replacement
ESMO PRECEPTORSHIP PROGRAMME
ESMO PRECEPTORSHIP PROGRAMME
Questions
� How frequent is PDL1- 100% positive??
� This patient had rather rapid progression but still responded well to Nivolumab - !!!
� I f we give Nivolumab Q montly why not Q 2 monthly??
� What is the optimal dose of Nivolumab? Will low dose Nivolumab work ?
ESMO Preceptorship Programme