Abstract
A 60-year-old male with cStage IVB lung cancer was treated with pembrolizumab. However, after five courses of pembrolizumab, he developed pembrolizumab-related cholangitis. Imaging studies showed enlargement and diffuse wall thickening of the gallbladder and mild dilation of the bile ducts without any obvious obstruction. As the patient experienced severe abdominal pain, we suspected bile stasis and performed biliary drainage. However, his condition did not improve, and he developed multiple liver abscesses and died during immunosuppressive therapy. Our case suggests that in ir-cholangitis, the indication and method of endoscopic retrograde cholangiopancreatography should be carefully judged.
Similar content being viewed by others
References
Brahmer JR, Tykodi SS, Chow LQ, et al. Safety and activity of anti-PD-L1 antibody in patients with advanced cancer. N Engl J Med. 2012;366:2455–65.
Hamid O, Robert C, Daud A, et al. Safety and tumor responses with lambrolizumab (anti-PD-1) in melanoma. N Engl J Med. 2013;369:134–44.
Rizvi NA, Mazieres J, Planchard D, et al. Activity and safety of nivolumab, an anti-PD-1 immune checkpoint inhibitor, for patients with advanced, refractory squamous non-small-cell lung cancer (CheckMate 063): a phase 2, single-arm trial. Lancet. 2015;16:257–265.
Motzer RJ, Escudier B, McDermott DF, et al. Nivolumab versus everolimus in advanced renal cell carcinoma. N Engl J Med. 2015;373:1803–13.
Kang YK, Boku N, Satoh T, et al. Nivolumab in patients with advanced gastric or gastro-esophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2): a randomised, double-bind, placebo-controlled, phase 3 trial. Lancet. 2017;390:2461–71.
Le DT, Kim TW, Custem EV, et al. Phase II open-label study of pembrolizumab in treatment-refractory, microsatelite instability-high/mismatch repair-deficient metastatic colorectal cancer: KEYNOTE-164. J Clin Oncol. 2020;38:11–9.
Friedman CF, Proverbs-Singh TA, Postow MA, et al. Treatment of the immune-related adverse effects of immune checkpoint inhibitors: a review. JAMA Oncol. 2016;2:1346–53.
Mizuno K, Ito T, Ishigami M, et al. Real world data of liver injury induced by immune checkpoint inhibitors in Japanese patients with advanced malignancies. J Gastoroenterol. 2020;55:653–61.
Darnell EP, Mooradian MJ, Baruch EN, et al. Immune-related adverse events (irAEs): diagnosis, management, and clinical pearls. Curr Oncol Rep. 2020;22:39.
Kawakami H, Tanizaki J, Tanaka K, et al. Imaging and clinicopathological features of nivolumab-related cholangitis in patients with non-small cell lung cancer. Invest New Drugs. 2017;35:529–36.
Koya Y, Shibata M, Shinohara N, et al. Secondary sclerosing cholangitis with hemobilia induced by pembrolizumab. Hepatol Res. 2019;49:950–6.
Hirasawa Y, Yoshimura K, Matsui H, et al. A case report on severe nibvolumab-induced adverse events similar to primary sclerosing cholangitis refractory to immunosuppressive therapy. Medicine. 2021;100:23.
Ogawa K, Kamimura K, Terai S. Antiprogrammed cell death-1 immunotherapy-related secondary sclerosing cholangitis. Hepatology. 2019;69:914–6.
Haanen JBAG, Carbonnel F, Robert C, et al. Management of toxicities from immunotherapy: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28:119–42.
Brahmer JR, Lacchetti C, Schneider BJ, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Practice Guideline. J Clin Oncol. 2018;36:1714–68.
Nakano K, Nishizawa M, Fukuda N, et al. Mycophenolate mofetil as a successful treatment of corticosteroid-resistant immune checkpoint inhibitor-induced hepatitis. Oxf Med Case Reports. 2020;4:1–3.
Kashima J, Okuma Y, Shimizuguchi R, Chiba K. Bile duct obstruction in a patient treated with nivolumab as second-line chemotherapy for advanced non-small-cell lung cancer: a case report. Cancer Immunol Immunother. 2018;67:61–5.
Kono M, Sakurai T, Okamoto K, et al. Efficacy and safety of chemotherapy following anti-PD-1 antibody therapy for gastric cancer: a case of sclerosing cholangitis. Intern Med. 2019;58:1263–6.
Kuraoka N, Hara K, Terai S, et al. Peroral cholangioscopy of nivolumab-related (induced) ulcerative cholangitis in a patient with non-small cell lung cancer. Endoscopy. 2018;50:E259-261.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval
Since this is a case report, it did not require ethical approval from our institution’s IRB.
Informed consent
Informed consent was not obtained from the patient in this reported case because he was dead, but formal consent is not required for this type of paper.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hori, H., Fujita, K., Nishio, A. et al. Pembrolizumab-related cholangitis with multiple fatal liver abscesses after endoscopic biliary drainage: a case report and review of the literature. Clin J Gastroenterol 15, 475–479 (2022). https://doi.org/10.1007/s12328-022-01593-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12328-022-01593-w