Nivolumab‑induced cholangitis in patients with non‑small cell lung cancer: Case series and a review of literature

Izumi,Hiroki; Kodani,Masahiro; Kurai,Jun; Takeda,Kenichi; Okazaki,Ryota; Yamane,Kohei; Teruya,Yasuhiko; Yamamoto,Akihiro; Sueda,Yuriko; Yanai,Masaaki; Tanaka,Natsumi; Sakamoto,Tomohiro; Yamaguchi,Kosuke; Makino,Haruhiko; Igishi,Tadashi; Yamasaki,Akira

doi:10.3892/mco.2019.1923

Nivolumab‑induced cholangitis in patients with non‑small cell lung cancer: Case series and a review of literature

Authors:
- Hiroki Izumi
- Masahiro Kodani
- Jun Kurai
- Kenichi Takeda
- Ryota Okazaki
- Kohei Yamane
- Yasuhiko Teruya
- Akihiro Yamamoto
- Yuriko Sueda
- Masaaki Yanai
- Natsumi Tanaka
- Tomohiro Sakamoto
- Kosuke Yamaguchi
- Haruhiko Makino
- Tadashi Igishi
- Akira Yamasaki
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Affiliations: Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Tottori 683‑8504, Japan
Published online on: September 18, 2019 https://doi.org/10.3892/mco.2019.1923
Pages: 439-446
Copyright: © Izumi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Immune checkpoint inhibitors (ICIs), including nivolumab, have exhibited substantial benefits in the treatment of several types of cancers. However, treatment with ICIs is often accompanied by immune‑related adverse events (irAEs), and a clear understanding of the precise indications and management of irAEs is important for harnessing the full potential of these agents. While skin‑ or gastrointestinal‑associated irAEs have been relatively well studied, there are few reports regarding nivolumab‑induced cholangitis. We retrospectively reviewed data from patients with advanced or recurrent non‑small cell lung cancer who were treated with nivolumab between December 2015 and December 2018 at Tottori University in Japan. Among the 59 patients, we identified four patients who experienced nivolumab‑induced cholangitis. Of these four patients, stable disease (SD) was observed in two patients (50%), while partial response (PR) was achieved in two patients (50%) under nivolumab treatment. Patients were treated with corticosteroid alone (n=2) or in combination with mycophenolate mofetil (MMF) (n=2); these treatments resulted in improvements in nivolumab‑induced cholangitis in three patients. In conclusion, the present retrospective study identified four cases of nivolumab‑induced cholangitis. The combination of corticosteroid and MMF was effective in two cases with grade 4 nivolumab‑induced cholangitis. Further reports are needed to establish the optimal management of patients with this irAE.

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