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