28121940 Visualization

A 68 Age - year Age - old Age female Sex smoker History with a history of pulmonary History embolism History and diabetes History mellitus History was diagnosed with Stage Detailed_description IIIB Detailed_description ( T4N2M0 Detailed_description ) squamous Detailed_description NSCLC Disease_disorder .
She was treated by definitive Detailed_description chemoradiotherapy Therapeutic_procedure with cisplatin Medication and vinorelbine Medication until Date September Date 2014 Date .
In Date October Date 2014 Date , positron Diagnostic_procedure emission Diagnostic_procedure tomography Diagnostic_procedure – computed Diagnostic_procedure tomography Diagnostic_procedure (PET Diagnostic_procedure - CT) Diagnostic_procedure scan demonstrated a good Lab_value response Lab_value in the primary Biological_structure lesion Biological_structure ; however, new metastases Sign_symptom in the right Biological_structure adrenal Biological_structure gland Biological_structure and right Biological_structure femur Biological_structure developed and were irradiated Therapeutic_procedure in Date November Date 2014 Date .
A Date month Date later Date the disease progressed with development of multiple Detailed_description bone Biological_structure and subcutaneous Biological_structure metastases Sign_symptom .
At that point, the patient suffered from severe Severity dyspnea Sign_symptom and was oxygen Therapeutic_procedure - dependent Therapeutic_procedure .
She received one Dosage cycle Dosage of carboplatin Medication and gemcitabine Medication followed by severe Severity pancytopenia Sign_symptom , and treatment was switched to nivolumab Medication 3 Dosage   mg/kg Dosage q14 Dosage days Dosage in Date January Date 2015 Date .
One Date week Date after Date the Date first Date cycle Date of Date nivolumab Date , a subcutaneous Biological_structure lesion Sign_symptom in her upper Biological_structure back Biological_structure grew Detailed_description substantially Detailed_description , accompanied by severe Severity pain Sign_symptom and significant Severity inflammatory Sign_symptom reaction Sign_symptom (Fig.1).
Other subcutaneous Biological_structure metastases Sign_symptom grew Detailed_description slightly Detailed_description as well.
After the second cycle of treatment marked symptomatic Sign_symptom improvement Sign_symptom was observed, including improvement Sign_symptom in Sign_symptom general Sign_symptom appearance Sign_symptom and dyspnea Sign_symptom and reduction of the bone Biological_structure pain Sign_symptom .
The patient no longer required oxygen Therapeutic_procedure supplementation Therapeutic_procedure .
The subcutaneous Biological_structure lesions Sign_symptom started to regress too, with complete Lab_value resolution Lab_value by Date the Date 12th Date week Date as well as improvement in all bone Biological_structure lesions Sign_symptom (Figs.1 ​and 2).
The patient continued on nivolumab Medication until Date June Date 2015 Date , and tolerated the treatment well.
Unfortunately, she developed bacterial Detailed_description aspiration Detailed_description pneumonia Sign_symptom and passed Outcome away Outcome in June Date 2015 Date .