Abstract
Our patient is a 69-year-old man who presented to the emergency department with left-sided hemiparesis that started 4 hours prior to presentation. Brain CT showed right basal ganglia and internal capsule haemorrhagic strokes. MRI revealed multiple brain lesions suspicious for metastases. Further workup revealed a 5 cm lung mass and a 1 cm pancreatic nodule. Biopsy of both pulmonary and pancreatic lesions was consistent with melanoma and was similar histologically. The patient underwent cyberknife stereotactic radiosurgery to the brain metastases followed by immunotherapy with pembrolizumab, and then by nivolumab and ipilimumab. The patient remains free of disease progression 2 years after treatment.
Keywords:
cancer intervention; lung cancer (oncology); respiratory medicine.
© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
MeSH terms
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Aged
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Antibodies, Monoclonal / administration & dosage
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Antibodies, Monoclonal, Humanized / administration & dosage
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Antineoplastic Agents, Immunological / administration & dosage
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Brain Neoplasms / diagnosis*
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Brain Neoplasms / drug therapy
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Brain Neoplasms / secondary
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Combined Modality Therapy
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Diagnosis, Differential
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Drug Administration Schedule
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Humans
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Ipilimumab / administration & dosage
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Lung Neoplasms / diagnosis*
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Lung Neoplasms / drug therapy
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Lung Neoplasms / pathology
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Magnetic Resonance Imaging
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Male
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Melanoma / diagnosis*
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Melanoma / secondary
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Melanoma / therapy
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Neoplasm Metastasis
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Nivolumab
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Pancreatic Neoplasms / diagnosis*
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Pancreatic Neoplasms / drug therapy
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Pancreatic Neoplasms / secondary
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Paresis / etiology
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Radiosurgery
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Stroke / complications
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Stroke / diagnosis
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Stroke / diagnostic imaging
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Tomography, X-Ray Computed
Substances
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Antibodies, Monoclonal
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Antibodies, Monoclonal, Humanized
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Antineoplastic Agents, Immunological
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Ipilimumab
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Nivolumab
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pembrolizumab