A 71-year-old woman was diagnosed with stage ⅢB locally advanced lung
squamous cell cancer(cT0N3M0).Programmed death-
ligand 1(PD-L1)immunostaining was negative.First -line
nedaplatin plus
docetaxel and second-line
carboplatin plus
nab-paclitaxel were followed by sequential thoracic
radiation therapy(60 Gy).The patient developed
radiation pneumonitis, but her condition improved with
corticosteroids.However, chest computed tomography(CT)revealed multiple nodules in both lungs.Third -line
carboplatin plus
tegafur/gimeracil/oteracil potassium(S-1)was not successful, and fourth- line
nivolumab(3mg/kg every 2weeks)was adopted.On day 9 after first administration, she developed
fever and radiation recall
pneumonitis.Multiple nodules rapidly formed, but they later gradually decreased in number.After 13 courses of
nivolumab, the nodules had disappeared completely.Mediastinal lymph nodes decreased in size, but an abdominal lymph node remained enlarged.Nivolumab was continued, and after 24 courses, the abdominal lymph node began to shrink, and the multiple lung
metastases continued to disappear.Currently, the best overall response is good partial response to
nivolumab.