A Successful Treatment Using Steroids for Nivolumab-Induced Colitis in a Patient with Metastatic Renal Cell Carcinoma

Abstract

We report the case of a 71-year-old woman with nivolumab-induced colitis, which was successfully treated with corticosteroid treatment. She underwent left-sided nephrectomy for renal cell carcinoma in 1989 at 43 years of age. Sorafenib was initiated in 2015 owing to progression of lung and adrenal metastasis; however, it was discontinued in 2016 secondary to nausea. In March 2017, she was switched to nivolumab administered as a biweekly dose of 3.0 mg/kg/day to treat worsening lung and adrenal metastasis. A partial response was observed after the administration of 7 cycles of nivolumab. In August 2017, she developed vomiting, severe diarrhea, and high fever after the administration of 10 cycles of nivolumab, necessitating admission to our hospital on an emergency basis. Initially, we suspected both, infectious enteritis and nivolumab-induced colitis, and she received meropenem; however, her symptoms persisted. Computed tomography showed intestinal wall thickening compatible with nivolumab-induced colitis. Thus, we initiated intravenous methylprednisolone therapy at a dose of 2.5 mg/kg/day. Her symptoms improved soon after the initiation of steroid, without any relapse. Nivolumab was discontinued based on the Immune-mediated Adverse Reactions Management Guide. Nivolumab-induced colitis may precipitate medical emergencies. Therefore, clinicians should be familiar with this condition and its appropriate management.