2021 Volume 67 Issue 3 Pages 193-199
A 62-year-old man who was initially diagnosed with Stage IVa squamous cell cancer of the hypopharynx, received concurrent chemoradiotherapy with cisplatin. As local recurrence was subsequently observed, he underwent total laryngopharyngectomy with free flap reconstruction. However, unresectable cervical lymph node metastasis was observed 3 months after the surgery. He was therefore treated with nivolumab as first-line therapy. As disease progression was observed after 4 courses of nivolumab, he was then treated with paclitaxel plus cetuximab as second-line therapy. He suddenly lost consciousness at home 2 days after 8 courses of the chemotherapy (11 months after the first administration of nivolumab). As elevated CK was observed in the laboratory test on admission, immune-related adverse events were initially suspected. The patient died without showing a response to steroid therapy, ventilator management, continuous hemodiafiltration and other treatments. The autopsy revealed a lack of cross-striation of skeletal muscle, indicating the existence of rhabdomyolysis. Although there have been few reports on rhabdomyolysis after nivolumab treatment date, this immune-related adverse events (irAEs) may be a potentially fatal adverse event.
