Figure 1a Figure 1b
Positron emission tomography, diagnosis; blue arrows show increased
uptake of 18F-Fluorodeoxyglucose in the peritoneal surface, prominently
in the pelvis and in the pericapsular area of the liver periphery,
SUVmax: 9.0 (F1a), 10 months
later, no pathological involvement was detected (F1b).
The patient underwent 2 cycles of intravenous chemotherapy with
cisplatin and pemetrexed (Pemetrexed 500 mg/m2/day in each cycle on days
1 and 21, Cisplatin 75 mg/m2/day on days 1 and day 21
in each cycle, totally 6 cycles were given). After 2 cycles of IV
chemotherapy, CRS and HIPEC with cisplatin were applied in purpose of
local disease control and to prevent relapse. Follow-up was done with
serial abdominal magnetic resonance imaging, they showed regression in
the disease findings. Because of a positive for Programmed Death Ligand
1 status, we started nivolumab at the 5th month of the chemotherapy.
Nivolumab treatment was given as 3 mg/kg/dose, every 2 weeks by IV
infusion over 1 hour. No disease activity was detected in the PET/CT
imaging performed 10 months after the diagnosis.
At the time of diagnosis and in the follow up, hepatic transaminase
level elevation (Grade1-2, CTCAE v5) observed in laboratory
examinations. In the 4th month of nivolumab, an increase in serum
creatinine value (Grade2, CTCAE v5) and hypertension (Grade3, CTCAE v5)
were detected. Considering the nephrotoxic effect of nivolumab, the drug
dose was reduced by 25%. After nivolumab dose reduction, kidney
functions, blood pressure monitoring and urine output turned back to
normal.
The patient was administered 32 courses of nivolumab without disease
relapse. The patient had been progression free for 20 months.