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Nivolumab/vinorelbine Biliary pancreatitis and Skin toxicity manifesting as photosensitivity and lower limbs oedema: case report

A 62-year-old man developed biliary pancreatitis during treatment with vinorelbine. Additionally, he developed skin toxicity manifesting as grade 2 photosensitivity and lower limbs oedema during treatment with nivolumab for metastatic squamous cell lung cancer [routes not stated; not all dosages and outcomes stated]. In June 2015, the man presented with history of cough, chest pain and poor haemoptoic expectoration. He underwent various investigations and was diagnosed with stage IV metastatic squamous cell lung cancer. He had a social history of drinking and smoking (more than 50 pack-years), and a medical history of abdominal aortic aneurysm, pulmonary mycetoma with Aspergillus spp and haemoptysis that required embolisation. In July 2015, treatment with paclitaxel and carboplatin was initiated. Following four cycles, a partial response was observed. In January 2017, he was diagnosed with paroxysmal atrial fibrillation and acute coronary syndrome with transient ST segment elevation. Thereafter, in April 2017, progression of metastatic squamous cell lung cancer was observed and treatment with vinorelbine and gemcitabine was initiated. After the second cycle, he experienced a decrease in neutrophil count (aetiology unknown). The dose of further chemotherapy was decreased. Following the third cycle of vinorelbine and gemcitabine, he was hospitalised due to biliary pancreatitis that was possibly related to vinorelbine. Hence, the man’s treatment with vinorelbine and gemcitabine was discontinued. In September 2017, a CT scan showed partial response and lymph node progression. Hence, treatment with nivolumab 3 mg/kg every two weeks was initiated. During the first cycle, he developed influenza syndrome (aetiology unknown). However, the treatment with nivolumab was not discontinued. Thereafter, a gradually improvement in the metastatic squamous cell lung cancer was noted. Following 8 months of treatment, he developed skin lesions on the sun-exposed areas. Additionally, mild oedema in the lower limbs was observed. After receiving 23 cycles, treatment with nivolumab was discontinued due to worsening of the skin toxicity that manifested as grade 2 photosensitivity. He developed lichenoid dermatitis on the right arm and actinic cheek keratosis with palpebral ectropium. From August 2018 till the time of report, he remained without pharmacological therapy and had stable disease for following 14 months. At the time of report, the skin toxicity had not recovered. Pampin-Sanchez R, et al. Long-term response control in a patient with metastatic squamous cell lung cancer after treatment with nivolumab: a case report. Journal of Oncology Pharmacy Practice 26: 1802-1806, No. 7, Oct 2020. Available from: URL: http://doi.org/10.1177/1078155220915774

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Reactions 5 Dec 2020 No. 1833