Nivolumab is approved for the treatment of patients with advanced non-small cell lung cancer （NSCLC）who experience progression of disease on or after standard platinum-based chemotherapy. But there are still a few reports of nivolumab treatment in after EGFR-TKI treatment since NSCLC patients with EGFR mutations has been said to have poor effect on anti-PD-1/PD-L1 agents. Also, there are several reports of severe interstitial pneumonitis when Nivolumab is used after EGFR-TKI treatment.
A88‐year‐old woman was diagnosed with lung adenocarcinoma with an EGFR exon21 L861Q mutation（clinical stage ⅢA ; cT4N0M0）. She had received Gefitinib for 18 months, until she had disease progression（PD）. Re-biopsy showed T790M-negative, ALK-negative and PD-L1 0%. Several other drugs were attempted after Gefitinib, but none of them showed any effect. Nivolumab treatment was initiated as her sixth chemotherapy, four and a half years after being diagnosed. Her tumor responded well to Nivolumab treatment and still remains effective without any severe side effects such as interstitial pneumonitis.
Our case suggests that Nivolumab treatment is a treatment option for NSCLC patients with EGFR uncommon mutations who are refractory to EGFR-TKI treatment
