Kataoka Seita, Moriguchi Michihisa, Okishio Shinya, Takahashi Aya, Okuda Keiichiro, Seko Yuya, Umemura Atushi, Yamaguchi Kanji, Miyagawa-Hayashino Aya, Itoh Yoshito
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
Departoment of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
Clin J Gastroenterol. 2022 Apr;15(2):467-474. doi: 10.1007/s12328-022-01590-z. Epub 2022 Feb 24.
Immune checkpoint inhibitors (ICIs) cause various immune-related adverse events (irAEs). We encountered a patient in whom nivolumab was re-administered effectively and safely treat laryngeal cancer after nivolumab-induced cholangitis. A 60-year-old man with metastatic laryngeal squamous cell carcinoma received 3rd-line treatment with nivolumab. After the 8th cycle of chemotherapy, laboratory tests revealed grade 3 elevations of gamma-glutamyl transpeptidase and alkaline phosphatase. Computed tomography and endoscopic retrograde cholangiopancreatography showed diffuse hypertrophy, dilation of bile ducts, and intrahepatic bile ducts with irregular walls and mild stenosis. The histologic findings of a liver biopsy revealed portal inflammation and cholangitis, mainly composed of T cell infiltration. We diagnosed nivolumab-induced cholangitis and administered 30 mg of prednisolone (0.5 mg/kg) and ursodeoxycholic acid (600 mg) per day. Although we initiated 4th-line cytotoxic anticancer drug after the cholangitis improved, the laryngeal cancer progressed rapidly. Based on the improvement in hematologic parameters, radiologic imaging, and pathologic findings, we cautiously restarted nivolumab. During the 30 months after re-administration of nivolumab, the cholangitis did not recur and the disease was well-controlled.
免疫检查点抑制剂（ICIs）会引发各种免疫相关不良事件（irAEs）。我们遇到一名患者，在纳武利尤单抗诱发胆管炎后，再次使用纳武利尤单抗有效地且安全地治疗喉癌。一名60岁转移性喉鳞状细胞癌男性患者接受了纳武利尤单抗的三线治疗。在第8周期化疗后，实验室检查显示γ-谷氨酰转肽酶和碱性磷酸酶升高至3级。计算机断层扫描和内镜逆行胰胆管造影显示弥漫性肥大、胆管扩张以及肝内胆管壁不规则和轻度狭窄。肝活检的组织学结果显示门脉炎症和胆管炎，主要由T细胞浸润组成。我们诊断为纳武利尤单抗诱发的胆管炎，并每天给予30毫克泼尼松龙（0.5毫克/千克）和熊去氧胆酸（600毫克）。尽管在胆管炎改善后我们开始了四线细胞毒性抗癌药物治疗，但喉癌进展迅速。基于血液学参数、影像学检查和病理结果的改善，我们谨慎地重新开始使用纳武利尤单抗。在重新使用纳武利尤单抗后的30个月里，胆管炎未复发，疾病得到良好控制。
