A Case Of Nivolumab-Induced Immune-Related Adverse Event In The Upper Gastrointestinal Tract In Recurrence/Metastatic Head And Neck Cancer.

Abstract

A 61-year-old male patient underwent partial glossectomy and right neck dissection for tongue cancer cT2N1MO. Because of the locoregional recurrence, the patient received neoadjuvant chemotherapy followed by subtotal glossectomy, neck dissection, and reconstruction. However, new locoregional lesions and distant metastasis were detected during postoperative chemotherapy. Seven courses of nivolumab were administered, but the tumor grew. Hence, the chemotherapy regimen was switched to paclitaxel and cetuximab. After eight courses of this regimen, leakage of liquid enteral nutrients around the gastrostoma began, and the patient was hospitalized urgently due to severe abdominal distension and nausea. Upper gastrointestinal endoscopy revealed edematous esophageal and gastric mucosa covered with white coating spots. Histopathological examination of the duodenal mucosa specimen showed CD8-+ natural killer (NK) T-cells infiltrating the lamina propria mucosae, which corresponded with an immune-related adverse event (irAE). Pulse steroid therapy significantly improved the findings of upper gastrointestinal endoscopy and symptoms.