Abstract
A 72-year-old woman with Renal Cell Carcinoma, on Nivolumab therapy for extensive metastatic disease, presented with dysphagia. Endoscopy revealed Grade 2 esophagitis with biopsy confirming active esophagitis. There was no histological evidence of an infectious or lymphoproliferative etiology. Nivolumab-induced esophagitis was suspected, and the medication was discontinued. There was dramatic clinical improvement with steroids. Immune checkpoint inhibitors are novel immunotherapeutic agents designed to restore the patientâs own antitumor immune responses. Nivolumab, an IgG4 monoclonal antibody that acts as an inhibitor of programmed death-1, is currently approved for clinical use in treatment of advanced stage malignancies. As Nivolumab is increasingly used in clinical oncology due to its efficacy and better tolerance compared to other chemotherapeutic agents, we present the second reported case of Nivolumab-associated esophagitis. Pathologists and clinicians should be aware of this possible complication to ensure its timely diagnosis and management.
Highlights
Recent advances in the understanding of immunology and cancer biology have resulted in the development of newer classes of drugs, immunomodulatory therapy in the management of cancers
Granulation tissue was present with lymphocytes, plasma cells, neutrophils, and scattered eosinophils in the lamina propria (Figure 3)
Nivolumab is a fully human immunoglobulin (IgG4) monoclonal antibody that interacts with the programmed death-1 (PD1), a cell surface transmembrane immune checkpoint receptor present on activated T-cells that plays a vital role in immune inhibition and antineoplastic activities
Summary
Recent advances in the understanding of immunology and cancer biology have resulted in the development of newer classes of drugs, immunomodulatory therapy in the management of cancers. An IgG4 monoclonal antibody that inhibits the programmed death-1 (PD-1) receptor, has revolutionized management of patients with cancer, and has been approved for treatment of metastatic melanoma, advanced non-small cell carcinoma (NSCLC) and renal cell carcinoma. As Nivolumab is increasingly used in oncology, the immunerelated adverse events may be more frequently being observed. Early recognition of pathological injury is critical
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