Bile duct obstruction in a patient treated with nivolumab as second-line chemotherapy for advanced non-small-cell lung cancer: a case report
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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.
KeywordsImmune-related adverse event Nivolumab Lung adenocarcinoma Cholangitis Cholecystitis
Endoscopic nasobiliary drainage
Endoscopic retrograde cholangiopancreatography
Immune-related adverse effects
Magnetic resonance cholangiopancreatography
Non-small-cell lung carcinoma
Programmed death receptor-1
Programmed death receptor ligand 1
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.
This report did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
For this type of study, formal consent is not required.
Informed consent was obtained from the patient presented in this article.
- 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
- 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
- 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.U.S.FDA. Administration (2014) KEYTRUDA (pembrolizumab) Injection label. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/125514lbl.pdf. Accessed 8 Apr 2017