Deep and Prolonged Response to Aurora A Kinase Inhibitor and Subsequently to Nivolumab in MYCL1-Driven Small-Cell Lung Cancer: Case Report and Literature Review

Figure 4

Top—PET-CT chest, abdomen, and pelvis before initiation of nivolumab (July 2015) showing R para-tracheal soft tissue thickening and 3.2 cm L para-tracheal lymph node (a), 2.6 cm R hepatic dome lesion (b), 3.8 cm R adrenal and 4.1 cm L adrenal nodules (c), and multiple pancreatic lesions in the head, body, and tail (c, d). In addition (not shown), the patient had other metastases involving bones, mediastinal and retroperitoneal lymph nodes, and pleural and peritoneal surfaces. The maximum SUV values for R-para-tracheal thickening, L para-tracheal lymph node, hepatic lesion, R adrenal nodule, L adrenal nodule, and pancreatic lesions were 5.2, 6.83, 13.08, 11.9, 9.9, and 11.4, respectively. Bottom—PET-CT chest, abdomen, and pelvis after 16 weeks of nivolumab (December 2015) showing resolution of L para-tracheal lymphadenopathy (a), decrease in R hepatic dome lesion to 1.2 cm (b), decrease in L adrenal nodule to 1.4 cm (c), and resolution of R adrenal (d), and all pancreatic lesions (c, d). Other metastatic lesions (not shown) in the bone, mediastinal and retroperitoneal lymph nodes, and pleural and peritoneal surfaces have completely resolved. The maximum SUV for R hepatic dome lesion has reduced from 13.08 to 2.0, and no increased metabolic activity was detected in the L adrenal nodule. Other than equivocal increased metabolic activity in previously irradiated R para-tracheal region (SUV 2.4), there was no increase in metabolic activity anywhere else.