Cancer Immunology, Immunotherapy

, Volume 67, Issue 8, pp 1325–1327 | Cite as

Immune-mediated cholangitis: is it always nivolumab’s fault?

  • Francesco Gelsomino
  • Giovanni Vitale
  • Andrea Ardizzoni
Letter to the Editors

Dear Editors,

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” [1].

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” [2] and one case of “small-duct cholangitis” [3]. 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...


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Kashima J, Okuma Y, Shimizuguchi R, Chiba K (2018) Bile duct obstruction in a patient treated with nivolumab as second-line chemotherapy for advanced non-small-cell lung cancer: a case report. Cancer Immunol Immunother 67:61–65. CrossRefPubMedGoogle Scholar
  2. 2.
    Kawakami H, Tanizaki J, Tanaka K et al (2017) Imaging and clinicopathological features of nivolumab-related cholangitis in patients with non-small cell lung cancer. Invest New Drugs 35:529–536CrossRefPubMedGoogle Scholar
  3. 3.
    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 28:671–672CrossRefPubMedGoogle Scholar
  4. 4.
    European Association for the Study of the Liver (2009) EASL Clinical Practice Guidelines: management of cholestatic liver diseases. J Hepatol 51:237–267CrossRefGoogle Scholar
  5. 5.
    Haanen JBAG., Carbonnel F, Robert C, Kerr KM, Peters S, Larkin J, Jordan K, ESMO Guidelines Committee (2017) Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 28(suppl_4):iv119-iv142CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Francesco Gelsomino
    • 1
  • Giovanni Vitale
    • 1
  • Andrea Ardizzoni
    • 1
  1. 1.Medical Oncology UnitPoliclinico S. Orsola-Malpighi, University of BolognaBolognaItaly

Personalised recommendations