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


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.


Immune-related adverse event Nivolumab Lung adenocarcinoma Cholangitis Cholecystitis 



Alkaline phosphatase


Alanine aminotransferase




Aspartate aminotransferase


Computed tomography


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 ( 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.


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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

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