A case of steroid responsive nivolumab-induced cholangitis

Abstract

Immune checkpoint inhibitors (ICIs) such as nivolumab are widely used agents in the treatment of a range of advanced malignancies given their demonstrated ability to achieve sustained clinical response and long-term survival in a significant subset of treated patients.1 ICIs enhance the endogenous anti-tumour immune response and hence are associated with a distinct set of immunologically-mediated toxicities referred to as immune related adverse events (irAEs). ICI-related cholangitis is a rare irAE which currently lacks established diagnostic criteria or treatment guidelines.2 Here we present a case of a 75-year-old female with non-small cell lung cancer treated with palliative nivolumab who subsequently developed nivolumab-induced small duct cholangitis which demonstrated an excellent response to corticosteroid therapy. We believe this is the first such reported Australian case. Given previous reports of poor corticosteroid response, more clinicopathological data is needed to characterise the potentially heterogeneous nature of ICI-cholangitis.3 Though a rare phenomenon, given the increasingly common use of these agents, it is an important reaction pattern of which pathologists and clinicians should be aware. 1.Yoneda K, Imanishi N, Ichiki Y, et al. Immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC). J UOEH 2018; 40: 173–89.2.Onoyama T, Takeda Y, Yamashita T, et al. Programmed cell death-1 inhibitor-related sclerosing cholangitis: A systematic review. World J Gastroenterol 2020; 26: 353–65.3.Talbot S, MacLaren V, Lafferty H. Sclerosing cholangitis in a patient treated with nivolumab. BMJ Case Rep 2021; 14: e241700.