A Case of Head and Neck Cancer Died of Lung Failure after a Single Administration of Nivolumab

Abstract

Nonresectable recurrent head and neck carcinoma is difficult to treat. Because most patients with recurrent head and neck cancer have exhausted the potential of surgery, radiotherapy and chemotherapy, nivolumab, an anti PD-1 antibody, began to be used after it became available in March 2017. We describe the case of a patient who died after a single administration of nivolumab. A 67-year-old man with squamous cell carcinoma of the head, neck and paranasopharynx underwent repeated chemotherapy and radiotherapy cycles for pulmonary metastases, however, he presented with multiple lung metastases again nine years after the initial treatment. Nivolumab was administered based on the expectation of long-term survival, but the patient developed generalized malaise and respiratory distress five days after administration of the drug. Chest computed tomography revealed evidence of pneumonia, but antibiotic administration proved ineffective and the patient died of respiratory failure 13 days after nivolumab administration. The cause of death was thought to be pneumonia caused by the infiltration of lymphocytes activated by the immune checkpoint inhibitor around the site of the lung metastasis and the irradiated area. Patients with head and neck cancer along with lung metastasis might be at an elevated risk for the development of pneumonitis. The decision to treat such patients with nivolumab should be made only after careful evaluation.