ArticleDiagnostics (Basel, Switzerland)2022
A Rare Case of Hepatic Vanishing Bile Duct Syndrome Occurring after Combination Therapy with Nivolumab and Cabozantinib in a Patient with Renal Carcinoma.
Article in Diagnostics (Basel, Switzerland), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 9 citations in OpenAlex.
- Hepatic and Pancreatobiliary Immune-Related Adverse Events in Patients Receiving Immune Checkpoint Inhibitors: A Multidisciplinary Approach.Biomedicines · 2026Review
- Rapid cholestasis improvement as key strategy for steroid-refractory immune-related cholangitis: A case report.World journal of gastrointestinal oncology · 2025Article
- Increased PD-1 expression in livers associated with PD-1-antibody-induced hepatotoxicity.BMC immunology · 2025Article
- Hepatotoxicity in Cancer Immunotherapy: Diagnosis, Management, and Future Perspectives.Cancers · 2024Review
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Authors and funding
11 authors at 1 institution in 1 country.
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Abstract
Tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) significantly improve the outcomes of patients with advanced clear cell renal cell carcinoma (ccRCC); however, high-grade toxicities can occur, particularly during combination therapy. Herein, we report a patient with advanced metastatic ccRCC, who developed grade 4 cholestasis during combined therapy with nivolumab and cabozantinib. After the exclusion of common disorders associated with cholestasis and a failure of corticosteroids (CS), a liver biopsy was performed that demonstrated severe ductopenia. Consequently, a diagnosis of vanishing bile duct syndrome related to TKI and ICI administration was made, resulting in CS discontinuation and ursodeoxycholic acid administration. After a 7-month follow-up, liver tests had returned to normal values. Immunological studies revealed that our patient had developed robust T-cells and macrophages infiltrates in his lung metastasis, as well as in skin and liver tissues at the onset of toxicities. At the same time, peripheral blood immunophenotyping revealed significant changes in T-cell subsets, suggesting their potential role in the pathophysiology of the disease.
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