Cancer Immunology, Immunotherapy

, Volume 67, Issue 1, pp 61–65 | Cite as

Bile duct obstruction in a patient treated with nivolumab as second-line chemotherapy for advanced non-small-cell lung cancer: a case report

  • Jumpei Kashima
  • Yusuke Okuma
  • Ryoko Shimizuguchi
  • Kazuro Chiba
Original Article

Abstract

Immune checkpoint inhibitors (ICIs) are becoming a standard therapy for non-small-cell lung cancer in the advanced stage. As these ICIs become widely available in clinical practice, immune-related adverse effects will become more common. Here we report a patient with lung adenocarcinoma who was treated with nivolumab and developed obstruction because of biliary inflammation. A 63-year-old Japanese man having lung adenocarcinoma with pleural dissemination complained of epigastric pain on the fifth cycle of nivolumab. Computed tomography showed wall thickening at the lower part of the bile duct and cholecystitis. Endoscopic retrograde cholangiopancreatography was repeatedly performed for drainage and stenting of the bile duct. Biopsies did not show obvious malignancy. Laboratory data on day 85 demonstrated grade 3 elevation of serum alkaline phosphatase, transaminase, and amylase levels. We initiated high-dose oral prednisone, resulting in gradual improvement of symptoms and laboratory data. Follow-up magnetic resonance cholangiopancreatography demonstrated no progression of duct obstruction, which confirmed the absence of biliary malignancy. Combined with results from previous reports, nivolumab may cause extrahepatic cholangitis.

Keywords

Immune-related adverse event Nivolumab Lung adenocarcinoma Cholangitis Cholecystitis 

Abbreviations

ALP

Alkaline phosphatase

ALT

Alanine aminotransferase

Amy

Amylase

AST

Aspartate aminotransferase

CT

Computed tomography

ENBD

Endoscopic nasobiliary drainage

ERCP

Endoscopic retrograde cholangiopancreatography

irAEs

Immune-related adverse effects

MRCP

Magnetic resonance cholangiopancreatography

NSCLC

Non-small-cell lung carcinoma

PD-1

Programmed death receptor-1

PD-L1

Programmed death receptor ligand 1

Notes

Acknowledgement

The authors would like to thank Enago (https://www.enago.jp) for the English language review.

Compliance with ethical standards

Conflict of interests

The authors declare that they have no conflict of interest.

Funding sources

This report did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from the patient presented in this article.

References

  1. 1.
    Melosky B, Chu Q, Juergens R, Leighl N, McLeod D, Hirsh V (2016) Pointed progress in second-line advanced non-small-cell lung cancer: the rapidly evolving field of checkpoint inhibition. J Clin Oncol 34(14):1676–1688CrossRefPubMedGoogle Scholar
  2. 2.
    Brahmer J, Reckamp KL, Baas P, Crinò L, Eberhardt WE, Poddubskaya E, Antonia S, Pluzanski A, Vokes EE, Holgado E, Waterhouse D (2015) Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med 373(2):123–135CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Borghaei H, Paz-Ares L, Horn L, Spigel DR, Steins M, Ready NE, Chow LQ, Vokes EE, Felip E, Holgado E, Barlesi F (2015) Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med 373(17):1627–1639CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Ohara H, Okazaki K, Tsubouchi H, Inui K, Kawa S, Kamisawa T, Tazuma S, Uchida K, Hirano K, Yoshida H, Nishino T (2012) Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012. J Hepatobiliary Pancreat Sci 19(5):536–542CrossRefPubMedGoogle Scholar
  5. 5.
    U.S.FDA. Administration (2014) OPDIVO (nivolumab) Injection label. http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/125554lbl.pdf. Accessed 8 Apr 2017
  6. 6.
    Ikeuchi K, Okuma Y, Tabata T (2016) Immune-related pancreatitis secondary to nivolumab in a patient with recurrent lung adenocarcinoma: A case report. Lung Cancer 99:148–150CrossRefPubMedGoogle Scholar
  7. 7.
    Champiat S, Lambotte O, Barreau E, Belkhir R, Berdelou A, Carbonnel F, Cauquil C, Chanson P, Collins M, Durrbach A, Ederhy S (2016) Management of immune checkpoint blockade dysimmune toxicities: a collaborative position paper. Ann Oncol 27(4):559–574CrossRefPubMedGoogle Scholar
  8. 8.
    Kawakami H, Tanizaki J, Tanaka K, Haratani K, Hayashi H, Takeda M, Kamata K, Takenaka M, Kimura M, Chikugo K, Sato T, Kudo M, Ito A, Nakagawa K (2017) Imaging and clinicopathological features of nivolumab-related cholangitis in patients with non-small cell lung cancer. Invest New Drugs 35:529–536CrossRefPubMedGoogle Scholar
  9. 9.
    Gelsomino F, Vitale G, D’Errico A, Bertuzzi C, Andreone P, Ardizzoni A (2017) Nivolumab-induced cholangitic liver disease: a novel form of serious liver injury. Ann Oncol 28(3):671–672PubMedGoogle Scholar
  10. 10.
    Brahmer JR, Drake CG, Wollner I, Powderly JD, Picus J, Sharfman WH, Stankevich E, Pons A, Salay TM, McMiller TL, Gilson MM (2010) Phase I study of single-agent anti–programmed death-1 (MDX-1106) in refractory solid tumors: safety, clinical activity, pharmacodynamics, and immunologic correlates. J Clin Oncol 28(19):3167–3175CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    U.S.FDA. Administration (2014) KEYTRUDA (pembrolizumab) Injection label. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/125514lbl.pdf. Accessed 8 Apr 2017

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Jumpei Kashima
    • 1
  • Yusuke Okuma
    • 2
    • 4
  • Ryoko Shimizuguchi
    • 3
  • Kazuro Chiba
    • 3
  1. 1.Department of PathologyTokyo Metropolitan Cancer and Infectious diseases Center Komagome HospitalTokyoJapan
  2. 2.Department of Thoracic Oncology and Respiratory MedicineTokyo Metropolitan Cancer and Infectious diseases Center Komagome HospitalTokyoJapan
  3. 3.Department of GastroenterologyTokyo Metropolitan Cancer and Infectious diseases Center Komagome HospitalTokyoJapan
  4. 4.Division of OncologyResearch Center for Medical SciencesTokyoJapan

Personalised recommendations