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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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Cancer Immunology, Immunotherapy Aims and scope Submit manuscript

A Letter to the Editors to this article was published on 05 April 2018

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.

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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

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Acknowledgement

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

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Authors and Affiliations

  1. Department of Pathology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Honkomagome 3-18-22, Bunkyo, Tokyo, 113-8677, Japan

    Jumpei Kashima

  2. Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Honkomagome 3-18-22, Bunkyo, Tokyo, 113-8677, Japan

    Yusuke Okuma

  3. Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Honkomagome 3-18-22, Bunkyo, Tokyo, 113-8677, Japan

    Ryoko Shimizuguchi & Kazuro Chiba

  4. Division of Oncology, Research Center for Medical Sciences, Nishi-Shimbashi 3-25-8, Minato, Tokyo, 105-8461, Japan

    Yusuke Okuma

Authors
  1. Jumpei Kashima
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  2. Yusuke Okuma
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  4. Kazuro Chiba
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Correspondence to Yusuke Okuma.

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The authors declare that they have no conflict of interest.

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

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

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

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Kashima, J., Okuma, Y., Shimizuguchi, R. et al. 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 (2018). https://doi.org/10.1007/s00262-017-2062-3

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  • DOI: https://doi.org/10.1007/s00262-017-2062-3

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