Abstract 161
Case Summary
There is increasing interest in combination of immunotherapy and radiotherapy in treatment of various solid tumours. In a phase 2 trial, Welsh et al reported that between 30 to 60 per cent of patients who underwent concurrent or sequential ipilumumab and radiotherapy had a stable disease. We report our experience in the use of concurrent nivolumab and radiotherapy. A 55-year-old gentleman was initially diagnosed in July 2014 with de novo stage IV lung squamous cell carcinoma with liver metastasis. He received 6 cycles of carboplatin and gemcitabine, followed by radiotherapy to the right lung mass (50Gy in 20 fractions) for local control. His disease then relapsed in the liver in December 2015 and he was treated with radiofrequency ablation of the liver metastasis. He was commenced on nivolumab 3mg/kg every 2 weeks since June 2016. His disease remained stable while ongoing nivolumab. In view of financial constraint, he planned to stop the nivolumab in July 2017. In April 2017, we delivered radiotherapy to the main bulk of the disease i.e. right lung, liver and right supraviclavicular fossa (20Gy in 5 fractions). The nivolumab was stopped in July 2017. Reassessment PET scan in July after the final cycle of nivolumab showed disease progression in the lung and liver. Unfortunately, he succumbed in September 2017 due to the lung cancer. Progression-free survival derived from the nivolumab was 13.7 months; while overall survival was 15.2 months. Use of immunotherapy and radiotherapy may offer good disease control in stage IV lung cancer. There are still many unanswered questions in this topic such as dose and timing of radiotherapy and patient selection who may benefit from this regimen.