Nivolumab
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Immune-related hepatitis and fever: case report A 47-year-old woman developed immune-related hepatitis and fever during treatment with nivolumab for ovarian cancer. The woman was admitted due to the sustaining fever, abdominal bulge, fatigue chest distress and short breath in September 2018. She had a history of ovarian cystadenocarcinoma associated with omental metastasis. Previously, she underwent transabdominal epifascial hysterectomy, greater omentectomy, double adnexectomy, cytoreductive surgery and appendicectomy. She was treated carboplatin, cisplatin, paclitaxel, bevacizumab and gemcitabine. However, she was less able to tolerate the chemotherapy. She started receiving nivolumab 100mg every 2 weeks [route not stated] since September 2018. Within the initial 2 months of treatment, a CT scan showed tumor size was increased from and an unconfirmed progression was observed. She experienced an elevation of ALT and AST. Based on these findings, she was diagnosed with immune-related hepatitis. The presence of liver irAE might suggested she might be benefiting from immunotherapy even though the tumor was enlarged. Thus, it was considered that she might experience a pseudo-progression. Thus, nivolumab was continued. Eventually, the tumor biomarker cancer antigen dropped. In January 2019, (4 months treatment of nivolumab), her fatigue symptom improved and tumor size was decreased further. It was concluded that she reached a partial response. The progression-free survival was about 9 months. She also experienced nivolimab-related side effect in the form of fever with body temperature of 40.2°C after the first administration [times to reactions onsets not stated]. The woman’s body temperature return to normal with physical cooling. On 28 November 2018, she received methylprednisolone to treat the hepatitis. Eventually, ALT and AST gradually returned to normal. Li H, et al. Early Onset Immune-Related Adverse Event to Identify Pseudo-Progression in a Patient With Ovarian Cancer Treated With Nivolumab: A Case Report and 803500477 Review of the Literature. Frontiers in Medicine 7: 366, 28 Jul 2020. Available from: URL: http://doi.org/10.3389/fmed.2020.00366
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Reactions 12 Sep 2020 No. 1821
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