Hepatobiliary and Pancreatic: Nivolumab-related cholangiopathy.
(2018) Journal of gastroenterology and hepatology — Vol. 33, n° 10, p. 1695 (2018)
Files
JournalofGastroenterologyandHepatology2018Nivolumab.pdf
Open Access - Adobe PDF
- 349.64 KB
Details
- Authors
- Abstract
- (en) A 71-year-old caucasian man developed a new onset cholestasis of unknown origin. His past medical history includes non-small cell lung cancer with cerebral metastasis treated by surgery, chemotherapy and nivolumab immunotherapy. Blood analysis showed dominant cholestasis together with a low increase in liver transaminases. Serological tests for viral hepatitis and antibodies associated with autoimmune hepatitis or cholangitis were negative. Abdominal computed tomography with contrast was normal. Magnetic resonance cholangiopancreatography demonstrated signs of intrahepatic cholangitis. Liver biopsy showed severe portal inflammation, mainly composed of CD8+T-lymphocytes, associating biliary damages and cholangitis. Nivolumab was thus stopped after 6 injections and was followed by a slow decrease of liver enzymes. Twelve weeks after the end of nivolumab, we observed a complete normalization of liver enzymes. Nivolumab, used for the treatment of several solid tumors including melanoma and non-small cell lung cancer, is an anti-programmed cell death-1 (PD-1) monoclonal antibody leading to the recovery of immune competence against tumor cells. We present here the first case of nivolumab-related cholangitis with MRI features of intrahepatic cholangitis. The hypothesis regarding such side effect is that inhibition of PD-1 pathway could lead to an abnormal activation of the immune system without any recognition of normal own cells. Time to resolution of liver enzymes is known to be very long. Further studies will be important to establish the optimal management of patients developing cholangitis when taking nivolumab.[...]
- Affiliations
Citations
Hamoir, C., de Vos, M., Clinckart, F., Nicaise, G., Komuta, M., & Lanthier, N. (2018). Hepatobiliary and Pancreatic: Nivolumab-related cholangiopathy. Journal of gastroenterology and hepatology, 33(10), 1695. https://doi.org/10.1111/jgh.14136 (Original work published 2018)