2017 Volume 57 Issue 3 Pages 226-231
Background. Nivolumab, an anti-programmed death-1 specific monoclonal antibody, has become a standard second-line chemotherapy agent for metastatic non-small cell lung cancer (NSCLC). Nivolumab induces several autoimmune adverse events, defined as immune-related adverse events (irAEs). Two cases of adrenocortical insufficiency have been experienced in Japanese investigational drug trials against NSCLC, but the details have not yet been published. No such cases have been reported in global clinical trials. This is the first case report of ACTH deficiency associated with secondary adrenocortical insufficiency induced by nivolumab in practical use for metastatic NSCLC. Case. A 65-year-old man with stage IIIB lung squamous cell carcinoma was treated with nivolumab as second-line therapy. After 12 cycles of nivolumab, the patient developed appetite loss, general fatigue, low blood pressure and body weight loss. These symptoms were strongly suggested to be related to adrenocortical insufficiency. Endocrinological examinations suggested isolated ACTH deficiency. The symptoms of appetite loss and general fatigue were improved, and the blood pressure was normalized soon after the initiation of treatment with prednisolone. Two weeks later, the performance status (PS) dramatically improved when the patient was discharged. Conclusion. This is the first report of nivolumab-induced ACTH deficiency associated with secondary adrenocortical insufficiency demonstrated by endocrinological tests in practical use for metastatic NSCLC. irAEs, which are associated with immune checkpoint inhibitors, vary in presentation and can be difficult to diagnose. Such events should be carefully checked for in order to ensure their timely management. It may be wise to perform blood biochemical examinations at baseline and before the administration of each nivolumab dose.
