Figure 2. PET CT scan
(A) A 3.4-cm primary tumor in the right upper lobe; (B) mediastinal
lymph node metastases; (C) large metastatic lesion in the right adrenal
gland; and (D) multiple bone metastases. CT, computed tomography; PET,
positron emission tomography
On February 22nd of year X, the patient’s condition deteriorated and he
was admitted due to respiratory distress with an SpO2 of
88%. He was assigned performance status 2 (PS2) because of his
inability to walk owing to right femoral bone metastasis. After
obtaining informed consent, combination ipilimumab-nivolumab (nivolumab
at a dose of 360 mg every 3 weeks plus ipilimumab at a dose of 1 mg/kg
every 6 weeks) were initiated on February 24th of same year. Thereafter,
home oxygen therapy was initiated, and combination ipilimumab-nivolumab
was administered on an outpatient basis. On June 1st of the same year at
the end of the second course, a repeat CT scan showed that the primary
tumor and metastases had shrunk (Figure 3). The tumor progression was
judged to have stabilized, according to the revised “Response
Evaluation Criteria in Solid Tumors” guidelines (version
1.1).8