Ipilimumab/nivolumab

Abstract

A 71-year-old man developed oesophagitis during treatment with nivolumab and ipilimumab for metastatic right renal cell carcinoma.The man, who was on haemodialysis, was diagnosed with metastatic right renal cell carcinoma. He started receiving immunotherapy with nivolumab and ipilimumab every 3 weeks [routes and doses not stated]. However, after two doses of immunotherapy, he developed anorexia and nausea. Oesophagogastroduodenoscopy revealed whitish oedematous mucosa with longitudinal sloughing in the lower and middle oesophagus. Endoscopic contact easily exfoliated oesophageal mucosa, consistent with oesophagitis dissecans superficialis. No abnormalities in the stomach or duodenum were observed. Biopsy revealed necrosis and sloughing of superficial squamous epithelium with lymphocytic inflammation and the presence of only a few apoptotic cells. He was diagnosed with oesophagitis secondary to immunotherapy with nivolumab and ipilimumab.Immunotherapy was discontinued. The man was hospitalised and received methylprednisolone. He experienced complete relief of digestive symptoms within a few days. Endoscopy after 2 weeks revealed improvement of oesophageal mucosa with normal pathological findings.