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Lack of efficacy and pneumonitis: 4 case reports In a prospective study of 70 patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors between 2016 and 2019, four patients [3 men and 1 woman] aged between 47–75 years were described, out of which, two men experienced lack of efficacy following treatment with nivolumab or durvalumab for bronchogenic carcinoma, and remaining man and a woman developed pneumonitis during treatment with atezolizumab or durvalumab for bronchogenic carcinoma [routes and not all dosages stated]. A 47-year-old man, experienced lack of efficacy following treatment with nivolumab for bronchogenic carcinoma. The man was diagnosed with an adenocarcinoma of the right upper lobe of the lung. Initially, he underwent lobectomy, and later developed distant metastasis and received chemotherapy with cisplatin and pemetrexed. However, disease progressed and thus, he started receiving nivolumab 3 mg/kg every 2 weeks. After 4 weeks, the tumor diameter remained mainly unchanged at 25mm. Based on his clinical performance, nivolumab therapy was continued and 26 weeks after treatment initiation, the tumor was smaller at 14mm and remained unchanged until 46 weeks after treatment, after which time the tumor progressed (lack of efficacy). A 52-year-old man, experienced lack of efficacy following treatment with durvalumab for bronchogenic carcinoma. The man was diagnosed with an adenocarcinoma of the right lower lobe of the lung with positive ipsilateral mediastinal (N2) lymph nodes (stage IIIA). Initially, he received chemoradiotherapy. After completion of chemoradiotherapy, he started receiving durvalumab treatment. After 4 weeks, a new, focal FDG uptake was visible in the thoracic vertebral body IV. Treatment was continued and, a PET/CT scan after 10 weeks of treatment, did not show any increased FDG uptake. However, a CT scan revealed a 10×10mm sclerotic lesion. This was classified as pseudoprogression. However, durvalumab treatment was continued and the disease progressed after 31 weeks of treatment initiation not only at lymph node metastasis and on the primary tumor side, but also on the bone metastasis on the thoracic vertebral body IV (lack of efficacy). A 75-year-old man, developed pneumonitis during treatment with atezolizumab for bronchogenic carcinoma. The man was diagnosed with stage IV disease. He started receiving atezolizumab treatment. Four weeks later, he developed increasing shortness of breath and worsened general condition. A PET/CT scan revealed considerable newly developed ground-glass opacities in bilateral lungs, with increased glucose activity, as well as metabolically active mediastinal lymphadenopathy. The findings supported the diagnosis of pneumonitis. Subsequently, both cerebral and lung metastasis showed shrinkage. He was treated with cortisone and atezolizumab was paused. Consequently, his general condition improved. A second follow-up examination 7 weeks later, showed a further reduction in the size of the cerebral metastasis and a