Re: Long-term control in a patient with metastatic lung adenocarcinoma after discontinuation of nivolumab.

We would like to thank the authors for their keen interest in our case “Long-term response control in a patient with metastatic squamous cell lung cancer after treatment with nivolumab: a case reported” and sharing your experience with us. Effectively, your case is a particular one, since it presented a EGFR mutation and the patient could be treated with both EGFR-TKI and immune checkpoint inhibitors.

We agree with you when you point that it is desirable to refrain from high-dose corticosteroid administration in order to sustain the effects of immunotherapy, especially when side effects can be controlled with other treatments.

It is interesting to observe that both tumor control and side effects persist over the time, as happened to our patient who had to go through surgery for the bilateral ectropion he presented, while the rest of cutaneous toxicities are still evident. In the last computed tomography of February 26, 2021, we checked that the tumor remains in response, observing a lesion with a residual aspect in both pulmonary vertices without changes in appearance or size. Our patient is asymptomatic at this time, maintaining a durable response after 2 years and 8 months of discontinuation of nivolumab due to immune-related skin toxicities.