Atezolizumab-induced Sclerosing Cholangitis in a patient with lung cancer: A case report
Atezolizumab is an immune checkpoint inhibitor that is a key drug in non-small-cell lung cancer treatment. However, it can cause immune-related adverse events, including liver injury. Several patterns of liver injury associated with immune checkpoint inhibitor therapy have been reported; however, no...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-01-01
|
| Series: | Cancer Treatment and Research Communications |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468294220301052 |
| _version_ | 1819009468966371328 |
|---|---|
| author | Shinji Nabeshima Masahiro Yamasaki Naoko Matsumoto Shintaro Takaki Yumi Nishi Kazuma Kawamoto Masaya Taniwaki Nobuyuki Ohashi Noboru Hattori |
| author_facet | Shinji Nabeshima Masahiro Yamasaki Naoko Matsumoto Shintaro Takaki Yumi Nishi Kazuma Kawamoto Masaya Taniwaki Nobuyuki Ohashi Noboru Hattori |
| author_sort | Shinji Nabeshima |
| collection | DOAJ |
| description | Atezolizumab is an immune checkpoint inhibitor that is a key drug in non-small-cell lung cancer treatment. However, it can cause immune-related adverse events, including liver injury. Several patterns of liver injury associated with immune checkpoint inhibitor therapy have been reported; however, not much is known about sclerosing cholangitis. We present here a case of lung adenocarcinoma with atezolizumab-induced secondary sclerosing cholangitis diagnosed using needle biopsy of the liver. A 77-year-old woman with lung adenocarcinoma, cT3N2M0, stage IIIA, was treated with concurrent chemoradiotherapy involving carboplatin and paclitaxel, which markedly reduced the tumor diameter. However, 5 months later, the lesion regrew, and she underwent 39 cycles of pemetrexed monotherapy. As pulmonary metastasis progressed, she was treated with atezolizumab. After 13 cycles of atezolizumab therapy, she complained of nausea. Laboratory tests showed elevated levels of the biliary tract and hepatic enzymes. Nevertheless, abdominal computed tomography and ultrasonography revealed no underlying related cause. Ultrasound-guided needle biopsy of the liver was performed, and histopathological analysis of biopsy samples showed features of sclerosing cholangitis. Further examinations were performed, and a diagnosis of atezolizumab-induced secondary sclerosing cholangitis without strictures and dilatations of the large bile ducts was established. Prednisolone was administered orally, after which the biliary tract and hepatic enzyme levels improved immediately. In patients presenting with a hepatic injury during immune checkpoint inhibitor therapy, clinicians should be aware of the possibility of immune checkpoint inhibitor-induced sclerosing cholangitis, even if the large bile ducts have no strictures and dilatations. |
| first_indexed | 2024-12-21T00:56:51Z |
| format | Article |
| id | doaj.art-2bc588b5ac404e88956bb8f1329917ab |
| institution | Directory Open Access Journal |
| issn | 2468-2942 |
| language | English |
| last_indexed | 2024-12-21T00:56:51Z |
| publishDate | 2021-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Cancer Treatment and Research Communications |
| spelling | doaj.art-2bc588b5ac404e88956bb8f1329917ab2022-12-21T19:21:16ZengElsevierCancer Treatment and Research Communications2468-29422021-01-0126100270Atezolizumab-induced Sclerosing Cholangitis in a patient with lung cancer: A case reportShinji Nabeshima0Masahiro Yamasaki1Naoko Matsumoto2Shintaro Takaki3Yumi Nishi4Kazuma Kawamoto5Masaya Taniwaki6Nobuyuki Ohashi7Noboru Hattori8Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, Japan; Corresponding author: Masahiro Yamasaki, Department of Respiratory Medicine, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima 730-8619, JapanDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanDepartment of Gastroenterology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, Japan; Ohashi Clinic, Naka-ku, Hiroshima, JapanDepartment of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima, JapanAtezolizumab is an immune checkpoint inhibitor that is a key drug in non-small-cell lung cancer treatment. However, it can cause immune-related adverse events, including liver injury. Several patterns of liver injury associated with immune checkpoint inhibitor therapy have been reported; however, not much is known about sclerosing cholangitis. We present here a case of lung adenocarcinoma with atezolizumab-induced secondary sclerosing cholangitis diagnosed using needle biopsy of the liver. A 77-year-old woman with lung adenocarcinoma, cT3N2M0, stage IIIA, was treated with concurrent chemoradiotherapy involving carboplatin and paclitaxel, which markedly reduced the tumor diameter. However, 5 months later, the lesion regrew, and she underwent 39 cycles of pemetrexed monotherapy. As pulmonary metastasis progressed, she was treated with atezolizumab. After 13 cycles of atezolizumab therapy, she complained of nausea. Laboratory tests showed elevated levels of the biliary tract and hepatic enzymes. Nevertheless, abdominal computed tomography and ultrasonography revealed no underlying related cause. Ultrasound-guided needle biopsy of the liver was performed, and histopathological analysis of biopsy samples showed features of sclerosing cholangitis. Further examinations were performed, and a diagnosis of atezolizumab-induced secondary sclerosing cholangitis without strictures and dilatations of the large bile ducts was established. Prednisolone was administered orally, after which the biliary tract and hepatic enzyme levels improved immediately. In patients presenting with a hepatic injury during immune checkpoint inhibitor therapy, clinicians should be aware of the possibility of immune checkpoint inhibitor-induced sclerosing cholangitis, even if the large bile ducts have no strictures and dilatations.http://www.sciencedirect.com/science/article/pii/S2468294220301052AtezolizumabImmune checkpoint inhibitorNon-small cell lung cancerSclerosing cholangitisHepatic injury |
| spellingShingle | Shinji Nabeshima Masahiro Yamasaki Naoko Matsumoto Shintaro Takaki Yumi Nishi Kazuma Kawamoto Masaya Taniwaki Nobuyuki Ohashi Noboru Hattori Atezolizumab-induced Sclerosing Cholangitis in a patient with lung cancer: A case report Cancer Treatment and Research Communications Atezolizumab Immune checkpoint inhibitor Non-small cell lung cancer Sclerosing cholangitis Hepatic injury |
| title | Atezolizumab-induced Sclerosing Cholangitis in a patient with lung cancer: A case report |
| title_full | Atezolizumab-induced Sclerosing Cholangitis in a patient with lung cancer: A case report |
| title_fullStr | Atezolizumab-induced Sclerosing Cholangitis in a patient with lung cancer: A case report |
| title_full_unstemmed | Atezolizumab-induced Sclerosing Cholangitis in a patient with lung cancer: A case report |
| title_short | Atezolizumab-induced Sclerosing Cholangitis in a patient with lung cancer: A case report |
| title_sort | atezolizumab induced sclerosing cholangitis in a patient with lung cancer a case report |
| topic | Atezolizumab Immune checkpoint inhibitor Non-small cell lung cancer Sclerosing cholangitis Hepatic injury |
| url | http://www.sciencedirect.com/science/article/pii/S2468294220301052 |
| work_keys_str_mv | AT shinjinabeshima atezolizumabinducedsclerosingcholangitisinapatientwithlungcanceracasereport AT masahiroyamasaki atezolizumabinducedsclerosingcholangitisinapatientwithlungcanceracasereport AT naokomatsumoto atezolizumabinducedsclerosingcholangitisinapatientwithlungcanceracasereport AT shintarotakaki atezolizumabinducedsclerosingcholangitisinapatientwithlungcanceracasereport AT yuminishi atezolizumabinducedsclerosingcholangitisinapatientwithlungcanceracasereport AT kazumakawamoto atezolizumabinducedsclerosingcholangitisinapatientwithlungcanceracasereport AT masayataniwaki atezolizumabinducedsclerosingcholangitisinapatientwithlungcanceracasereport AT nobuyukiohashi atezolizumabinducedsclerosingcholangitisinapatientwithlungcanceracasereport AT noboruhattori atezolizumabinducedsclerosingcholangitisinapatientwithlungcanceracasereport |