Squamous Cell Lung Cancer: Methotrexate Withdrawal Induced Spontaneous Regression Of Liver Metastases
Hashimoto, A., Kawasaki, Y., Tominaga, A., Kakutani, T., Kodama, K., Nogi, S., Tsuno, H., Ogihara, H., Nunokawa, T., Ikenaka, T., Watai, K., Saito, I., & Matsui, T. (2020). Squamous Cell Lung Cancer: Methotrexate Withdrawal Induced Spontaneous Regression of Liver Metastases. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 26(5), e137. https://doi.org/10.1097/RHU.0000000000001010
View Original Source →Abstract
Immune checkpoint inhibitors (ICIs) are the standard of care for the treatment of several cancers. While these immunotherapies have improved patient outcomes in many clinical settings, they bring accompanying risks of toxicity, specifically immune-related adverse events (irAEs). There is a need for clear, effective guidelines for the management of irAEs during ICI treatment, motivating the Society for Immunotherapy of Cancer (SITC) to convene an expert panel to develop a clinical practice guideline. The panel discussed the recognition and management of single and combination ICI irAEs and ultimately developed evidence- and consensus-based recommendations to assist medical professionals in clinical decision-making and to improve outcomes for patients.
Case Details
Disease Location
Liver
Personal Characteristics
72-year-old man. History of rheumatoid arthritis for 11 years. Treated with prednisolone, methotrexate (mtx), and salazosulfapyridine.
Clinical Characteristics
Contrast CT revealed a 1-cm pulmonary nodule and multiple low-density areas in the liver. 6 months later, a needle biopsy of the liver mass revealed atypical cells that were positive for cytokeratin (ck) ae1/ae3, ck 34βe12, p40, and p63 by immunohistochemical staining. Results suggested that the multiple liver masses were metastatic, poorly differentiated squamous cell carcinoma that originated from the primary lesion in the lung. At that point, methotrexate was discontinued.
Remission Characteristics
5 months after methotrexate discontinuation, a CT showed almost complete resolution of the small pulmonary nodule and disappearance of the multiple liver masses,
Treatment & Mechanisms
Proposed Remission Mechanisms
Cessation of mtx may contribute to the spontaneous regression of liver metastases in cases of squamous cell lung cancer.
Clinical Treatment
Biopsy prednisolone, salazosulfapyridine metrhotexate discontinuation