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Background <p>Neoadjuvant chemoimmunotherapy is becoming a mainstream treatment for primary lung cancer; however, delayed immune-related adverse events occurring at 3 months or more after discontinuation of treatment have not been reported in this patient population.</p> Case presentation <p>A 64-year-old man underwent bronchoscopic biopsy, revealing a lung adenocarcinoma (cT4N0M0, stage IIIA), and was treated with three courses of carboplatin, pemetrexed, and nivolumab as neoadjuvant chemoimmunotherapy. Four months after the first course of treatment, the patient underwent a left upper lobectomy with lymph node dissection. Although postoperative hoarseness occurred as a complication, he was discharged on postoperative day 12. On postoperative day 56, the patient developed shortness of breath. An increased inflammatory response and infiltrates in the right lower lobe suggested aspiration pneumonia; however, his condition failed to improve after 1 week of antibiotic therapy. Elevated KL-6 levels and worsening of a right lower lobe interstitial shadow were observed. On day 104 after immunotherapy, the patient was diagnosed with delayed drug-induced interstitial lung disease, and steroid therapy resulted in improvement.</p> Conclusions <p>In patients with a history of immune checkpoint inhibitor (ICI) administration, attention must be paid to the occurrence of immune-related adverse events, regardless of the duration of ICI administration or the time elapsed since discontinuation, and when diagnosed, treatment should be initiated immediately in accordance with guidelines.</p>

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Primary lung cancer with delayed drug-induced interstitial lung disease after neoadjuvant chemoimmunotherapy: a case report

  • 期刊论文

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  • 发表日期：

    2026年2月18日

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  • Hideomi Ichinokawa,
  • Takashi Sowa,
  • Takashi Yaguchi,
  • Yukio Watanabe,
  • Kazuya Takamochi,
  • Kenji Suzuki

摘要

Background

Neoadjuvant chemoimmunotherapy is becoming a mainstream treatment for primary lung cancer; however, delayed immune-related adverse events occurring at 3 months or more after discontinuation of treatment have not been reported in this patient population.

Case presentation

A 64-year-old man underwent bronchoscopic biopsy, revealing a lung adenocarcinoma (cT4N0M0, stage IIIA), and was treated with three courses of carboplatin, pemetrexed, and nivolumab as neoadjuvant chemoimmunotherapy. Four months after the first course of treatment, the patient underwent a left upper lobectomy with lymph node dissection. Although postoperative hoarseness occurred as a complication, he was discharged on postoperative day 12. On postoperative day 56, the patient developed shortness of breath. An increased inflammatory response and infiltrates in the right lower lobe suggested aspiration pneumonia; however, his condition failed to improve after 1 week of antibiotic therapy. Elevated KL-6 levels and worsening of a right lower lobe interstitial shadow were observed. On day 104 after immunotherapy, the patient was diagnosed with delayed drug-induced interstitial lung disease, and steroid therapy resulted in improvement.

Conclusions

In patients with a history of immune checkpoint inhibitor (ICI) administration, attention must be paid to the occurrence of immune-related adverse events, regardless of the duration of ICI administration or the time elapsed since discontinuation, and when diagnosed, treatment should be initiated immediately in accordance with guidelines.