Second follow-up CT scan after 6 months of durvalumab - pneumonitis

[u/Voinar]

My father was diagnosed with stage 3C lung cancer in October 2024.
Therapy: Chemotherapy and radiotherapy → result: tumor mass reduced from 7.5 cm to 4.5 cm.

He then started Durvalumab, initially twice a month, then once a month → first follow-up CT scan showed further reduction from 4.5 cm to 3,5 cm.
Second CT scan at 6 months: stable disease (a large area of parenchymal consolidation is observed with some associated bronchiectasis, mostly fibrotic in nature, in the apical-posterior segments of the right upper lung lobe, reduced in volume and related to post-radiation changes, with a heterogeneously hypodense area of pseudonodular morphology measuring about 35 mm corresponding to the known lesion, essentially stable. In the left lower lung lobe, multiple areas of parenchymal consolidation are noted, some with pseudonodular morphology, with perilobular aspects, predominantly peribronchovascular; findings consistent with foci of organizing pneumonia due to immunotherapy toxicity.)

The doctor has decided to temporarily stop the therapy and start a course of corticosteroids, and to reassess later the possibility of reintroducing Imfinzi.

Has anyone had similar experiences? Were you able to restart therapy without developing pneumonitis again?

My father is completely asymptomatic, feels well, and is able to walk. I honestly don’t know what to think. I am grateful that the disease is currently under control, but I don’t know what to expect in the future.

[u/FlyingFalcon1954]

This sure sounds similar to a situation I have been recently facing. I was diagnosed with stage 3b squamous cell in Nov. 2024. 5.5 cm right side hilar mediastinal tumor with local lymphadopathy and two smaller upper apical plueral area right lobe low SUV uptake nodules (1.8 & 2.0 SUV) on PET scan of 11/21/24. My second PET s.can of 6/15/25 this upper right lung area had two SUV readings of SUV uptake of 6.2 and 8.0. Quite a jump in activity.

From the very beginning and from the very first chest X rays to the next 3 CT scans and two PET scans my right upper lobe had continuous abnormal readings and descriptions depending on the individual interpreting the films. Descriptions ran from appears to be scarring from radiation (which I have yet to receive) to treatment related inflammation to bronchiectasis to cannot rule out underlying neoplasm. I also have no related symptoms. Even though the tumor board wanted to biopsy this area before consolidation radiation of the hilar tumor site to not miss a possible active cancer while we are using radiation. In short if this is active cancer they wanted to zap that at the same time as well.

My sequence of treatment was different than your Dads in that I did 5 rounds of carboplatin/paclitaxel + immuno opdivo/yervoy with the hope of shrinking the tumor and then hitting the remainder with radiation when chemo ended and after I had a month or so to rest. Because of this issue with the right upper lobe it has taken me over four months (that is another story about a comedy of errors and gross mismanagement of my treatment plan) after end of chemo to finally complete this upper lung biopsy and get all set up for consolidative IMRT. My radiation treatment is now considered "delayed treatment" but is still viable although just not as effective as it would have been at 4-8 weeks after chemo. It is now going to be applied at about 20 weeks after chemo treatment. During IMRT I will be pausing my immunotherapy that is projected to continue until 1/15/27 (another year and four months for a total of two years) which I am apprehensive about because not only did my tumors shrink because of my systemic treatments they miraculously shrunk my tumors and associated lymphadopathy all the way down to complete metabolic response = NED at the end of chemo 4/17/25. PET scan 5/17/25 and 6/15/25 CT scan both confirm no evidence of disease. They also do not typically do radiation with ongoing immune therapy because of the serious levels of inflammation that the two (IMRT & immune therapy) may generate in tandem. A least with my immune therapy that seems to be a major concern.

Today 8/28/25 at my radiation oncology appointment I finally got the results of the biopsy of 8/12/25 of my right upper lung lobe. Result = 1. Lung tissue with severe fibrosis and associated organizing lymphohistiocytic inflammation. 2. Negative for malignancy. 3. GMS stain negative for fungus and pneumocystis. 4. Kinyoun stain negative for acid-fast organisms. It is my understanding this "may be" a treatment induced inflammation situation but the oncology radiologist does not feel it is severe enough to not go forward with IMRT. He calls it a mess while I am simply happy that it is not more cancer appearing simultaneously as my other tumors were disappearing. That scenario never made sense to me. As I move forward I will be pausing immune therapy during IMRT and maybe this situation will clear up if it is immune therapy related. What I do know is that it has certainly been an unwelcome complication and a major hassle. Best of everything to you and your Dad. He is lucky to have you!