Nishiyama Akihiro, Sakaguchi Hiroyuki, Yanagimura Naohiro, Suzuki Chiaki, Otani Sakiko, Tanimoto Azusa, Yamashita Kaname, Takeuchi Shinji, Ohtsubo Koushiro, Ikeda Hiroko, Yano Seiji
Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan.
Department of Diagnostic Pathology, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan.
Oxf Med Case Reports. 2020 Dec 28;2020(12):omaa116. doi: 10.1093/omcr/omaa116. eCollection 2020 Dec.
Immune checkpoint inhibitors (ICIs) are widely used in both monotherapy and combination chemotherapy for various types of cancers. Nivolumab is the most popular among ICIs, and the number of adapted malignant diseases for nivolumab is increasing. Bronchoesophageal fistula formation is a serious complication of the treatment for esophageal or lung cancer. However, the development of bronchoesophageal fistula as a complication of ICIs is obscure. A 59-year-old man who was diagnosed with carcinoma of unknown primary with a subgroup of lung squamous cell carcinoma had bronchoesophageal fistula formation after three cycles of nivolumab as the fourth line treatment. Before the initiation of nivolumab, he had received two esophageal stents and an angiogenesis inhibitor. These are known risk factors for fistula formation. This is a rare case showing that nivolumab monotherapy might induce bronchoesophageal fistulae. Therefore, clinicians should be aware of the factors related to fistula formation when using ICIs.
免疫检查点抑制剂（ICIs）广泛应用于各类癌症的单药治疗和联合化疗。纳武单抗在ICIs中最受欢迎，且纳武单抗适用的恶性疾病数量正在增加。支气管食管瘘形成是食管癌或肺癌治疗的严重并发症。然而，作为ICIs并发症的支气管食管瘘的发生情况尚不清楚。一名59岁男性被诊断为原发灶不明癌且伴有肺鳞状细胞癌亚组，在接受纳武单抗作为四线治疗三个周期后出现支气管食管瘘形成。在开始使用纳武单抗之前，他曾接受过两个食管支架和一种血管生成抑制剂治疗。这些都是已知的瘘形成危险因素。这是一例罕见病例，表明纳武单抗单药治疗可能诱发支气管食管瘘。因此，临床医生在使用ICIs时应了解与瘘形成相关的因素。
