{
  "abstract": "Severe immune checkpoint inhibitor-related pneumonitis (CIP) typically leads to the permanent discontinuation of immunotherapy; however, its long-term oncological outcomes and late drug toxicity remain poorly defined. This report describes a patient with stage IV lung adenocarcinoma who, following recurrent grade 3 CIP, achieved durable systemic remission for more than 4 years and displayed a distinctive pattern of cerebral oligoprogression. A 66-year-old male patient with stage IV lung adenocarcinoma achieved a partial response (PR) after four cycles of sintilimab combined with chemotherapy. Three weeks after the last dose, he developed grade 3 CIP complicated by acute pulmonary embolism. Recurrence occurred twice because of overly rapid corticosteroid tapering and was ultimately controlled through an ultralow tapering regimen (50 mg/day prednisone initially, reduced by 5 mg per week) combined with pirfenidone for antifibrotic therapy. Following the resolution of CIP, no further systemic antitumor therapy was administered. During 48 months of follow-up, the patient maintained complete remission (CR) of extracranial metastases; the sole site of progression was a solitary cerebellar lesion, which exhibited three episodes of oligoprogression, each of which was successfully managed with either radiotherapy or bevacizumab-based therapy. At 34 months after the onset of CIP, the patient developed bilateral osteonecrosis of the femoral head (ONFH), with right-sided slight collapse (ARCO stage III) and left-sided stage I. This case suggests a potential synergistic toxic mechanism between cumulative corticosteroid exposure (approximately 7,300 mg prednisone equivalents) and VEGF inhibition-mediated microvascular injury. This case also suggests that ultralow corticosteroid tapering combined with antifibrotic therapy can effectively manage refractory CIP; the dissociation between durable peripheral immunological memory and isolated central nervous system (CNS) progression supports the hypothesis of CNS immune privilege. Finally, clinicians must remain vigilant about long-term musculoskeletal toxicity in long-term survivors of ICI therapy.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Respiratory and Critical Care Medicine, Zibo Central Hospital",
    "Department of Radiation Oncology, Zibo Central Hospital"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yanjun Xue"
    },
    {
      "affs": [
        0
      ],
      "name": "Aizhen Xu"
    },
    {
      "affs": [
        1
      ],
      "name": "Xin Tong"
    },
    {
      "affs": [
        0
      ],
      "name": "Xinda Yin"
    },
    {
      "affs": [
        0
      ],
      "name": "Lei Wei"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7eebkpwsracnv.bib",
  "cited_by": 0,
  "doi": "10.3389/fphar.2026.1932295",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13716585/?tool=EBI",
  "id": "7eebkpwsracnv",
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  "landing_url": "https://www.frontiersin.org/articles/10.3389/fphar.2026.1932295/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
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      "openalex",
      "2730|Cancer Immunotherapy and Biomarkers"
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  "pdf_url": "https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2026.1932295/pdf",
  "pmcid": "PMC13716585",
  "pmid": "42959096",
  "published": "2026-10-15",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/7eebkpwsracnv.ris",
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      "url": "https://www.frontiersin.org/articles/10.3389/fphar.2026.1932295/full"
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    {
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      "url": "https://europepmc.org/article/PMC/PMC13716585"
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    {
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    {
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Cancer Immunotherapy and Biomarkers",
      "subfield": "oncology"
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  ],
  "title": "Case Report: Four-year durable remission, cerebral oligoprogression, and femoral head necrosis following severe recurrent immune checkpoint inhibitor-related pneumonitis in a patient with stage IV lung adenocarcinoma",
  "title_text": "Case Report: Four-year durable remission, cerebral oligoprogression, and femoral head necrosis following severe recurrent immune checkpoint inhibitor-related pneumonitis in a patient with stage IV lung adenocarcinoma",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:21:04Z",
  "url": "https://research.draconitic.com/paper/7eebkpwsracnv",
  "venue": "Frontiers in Pharmacology",
  "versions": []
}