Table 1.
Timeline of care for all patients
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | |
|---|---|---|---|---|
| Initial diagnosis & intervention | - Left frontal glioblastoma - GTR - Radiation + concurrent TMZ - Nivolumab |
- Right temporal glioblastoma - GTR - Radiation + concurrent TMZ - Nivolumab |
- Right temporal glioblastoma - GTR - Radiation + concurrent TMZ - Ipilimumab |
- Left temporal glioblastoma - GTR - Radiation + concurrent TMZ - Ipilimumab |
| Changes on MRI brain #1 & clinical symptoms | - New enhancing lesion in the left frontal lobe distal to initial tumor - Clinically stable |
- New right temporal lesion at the site of intial resection - Focal seizure |
- 2 lesions in right temporal lobe near resection cavity - Asymptomatic |
- New enhancing lesion in left temporal lobe - Focal seizure |
| Time from initiation of ICPI #1 | - 2 months | - 2 months | - 5.5 months | - 8.5 months |
| Intervention #1 | - Biospy at 3.5 months of ICPI, when aphasia worse | - Resection at 5.5 months of ICPI, when lesion increased in size - Clinically stable |
- Resection at 8.5 months of ICPI, when lesion increased in size despite dexamethasone | - Resection at 9 months from ICPI |
| Pathology #1 | - Pseudoprogression | - Pseudoprogression | - Tumor progression | - Tumor progression |
| Treatment | - Continued nivolumab | - Continued nivolumab | - Discontinued ipilimumab - Concurrent radiation + off-label nivolumab |
- Discontinued ipilimumab - Re-radiation, low-dose bevacizumab and off-label nivolumab |
| Changes on MRI brain #2 & clinical symptoms | - Increased size of the left frontal lesion - Worsened aphasia, right-sided weakness and headaches |
- Increased size of right temporal lesion | ||
| Time from initiation of ICPI #2 | - 4.5 months from nivolumab initiation | |||
| Intervention #2 | - Trial of dexamethasone - Resection at 7 months of ICPI |
- Resection at 5 months from nivolumab initiation | ||
| Pathology #2 | Pseudoprogression | Pseudoprogression | ||
| Follow-up | - Stable at 12 months from diagnosis | - On nivolumab at 10 months from diagnosis | - Continued nivolumab, 19 months from diagnosis | - Continued nivolumab, 21 months from diagnosis |