The patient was 67-year-old woman with non-small cell lung carcinoma (squamous cell carcinoma, T2bN2M1a, Stage IVA) who was started on fifth-line therapy with nivolumab, an immune checkpoint inhibitor. Although tumor biopsy was negative for programmed cell death ligand 1 (PD-L1), the tumor size decreased. Nivolumab had to be discontinued due to suspected immune-related adverse events (i.e., skin rash and enteritis symptoms), but the tumor size reduction persisted after discontinuation and complete response was maintained for ≥ 8 months. After disease recurrence, nivolumab therapy was restarted. The tumor size decreased, and partial response was achieved and maintained. The disease was successfully controlled for ≥ 2 years (27 courses of nivolumab), when nivolumab therapy was again discontinued due to skin rash. Despite the PD-L1-negative status, the patient achieved long-term response to nivolumab therapy. The immune-related adverse events in this case were comparable between the initial and reintroduced nivolumab therapy, suggesting that nivolumab is safe to administer over the long term.

We report a case of a 72-year-old woman, who had an anastomotic pseudoaneurysm in the ascending aorta, successfully treated by endovascular aortic repair with vascular embolic devise and stent-graft. It seemed to be high risk to achieve conventional surgery with extracorporeal circulation, therefore we selected endovascular treatment because she had a bleeding tendency which derived from disseminated intravascular coagulation. Then, we adopted stent-grafting with a vascular embolic device, because the distal side of pseudoaneurysm had too short a landing zone to cover the stent-graft only. The patient well tolerated this procedure and her postoperative course was uneventful. The pseudoaneurysm shrank at 6th months after operation.