Immune-mediated cholangitis: is it always nivolumab’s fault?
We read with much interest the article published by Kashima and colleagues on “Bile duct obstruction in a patient treated with nivolumab as second-line chemotherapy for advanced non-small cell lung cancer: a case report” .
Immune-related AEs (irAEs) affecting the biliary system on treatment with immune-oncology (I-O) agents, such PD-1/PD-L1 mAbs, are considered rare and their management remains unclear.
Recently, four cases of nivolumab-related cholangitis have been reported in the literature, including three cases of “large-duct cholangitis”  and one case of “small-duct cholangitis” . None of the patients had a history of autoimmune disorders or IgG4-related disease and all showed a predominant elevation of alkaline phosphatase and gamma-glutamyltranspeptidase enzymes.
The three Japanese patients with “large-duct cholangitis” developed an extensive extrahepatic biliary tract dilation without obstruction that progressed during drug administration. However, a...
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Conflict of interest
All authors declare that they have no conflict of interest.