Department of Pathology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Honkomagome 3-18-22, Bunkyo, Tokyo, 113-8677, Japan.
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.
Cancer Immunol Immunother. 2018 Jan;67(1):61-65. doi: 10.1007/s00262-017-2062-3. Epub 2017 Sep 14.
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.
免疫检查点抑制剂（ICIs）已成为晚期非小细胞肺癌的标准治疗方法。随着这些 ICIs 在临床实践中的广泛应用，免疫相关不良反应将变得更加常见。在这里，我们报告了一例接受纳武利尤单抗治疗的肺腺癌患者，因胆管炎而发生梗阻。一名 63 岁的日本男性患有伴胸膜播散的肺腺癌，在纳武利尤单抗治疗的第五个周期时出现上腹痛。计算机断层扫描显示胆管下段壁增厚和胆囊炎。为了引流和胆管支架置入，反复进行了内镜逆行胰胆管造影术。活检未显示明显的恶性肿瘤。第 85 天的实验室数据显示血清碱性磷酸酶、转氨酶和淀粉酶水平升高 3 级。我们开始给予大剂量口服泼尼松，症状和实验室数据逐渐改善。随访磁共振胰胆管造影显示胆管梗阻无进展，证实无胆道恶性肿瘤。结合以往的报告结果，纳武利尤单抗可能会引起肝外胆管炎。
