Drug-associated abdominal aortitis and retroperitoneal fibrosis after treatment with nivolumab

Abstract

A 60-year-old man with metastatic supraglottic laryngeal cancer treated with nivolumab, an immune checkpoint inhibitor (ICI), developed abdominal aortitis and retroperitoneal fibrosis. The nivolumab was discontinued and no steroids were initiated. A literature search found 19 other cases of ICI-associated aortitis. The evidence is limited and conflicting on the optimal management of these rare but serious adverse events. With increasing application in the treatment of a multitude of cancer types, physicians must remain aware of aortitis as an adverse event and consider the potential risks vs benefits before initiating ICI treatment for their patient.

Keywords: Aortitis; Immune checkpoint inhibitors; Immunotherapy; Retroperitoneal fibrosis.

Fig 1

Enhanced computed tomography (CT) scan of the abdomen from May 2021. After 3 months of nivolumab therapy. Early infrarenal aortitis (1) with maximal aortic wall thickness measured at 4.2 mm. Mild aortic calcification is seen, which is stable from prior imaging.

Fig 2

Computed tomography (CT) angiography of the abdomen from April 2022. One month after the discontinuation of nivolumab. Infrarenal aortitis (1) with maximal aortic wall thickness measured at 16 mm and axial diameter 39.1 mm. New finding of retroperitoneal fibrosis (2).

Fig 3

Computed tomography (CT) angiography of the abdomen from September 2022. Six months after the discontinuation of nivolumab. Infrarenal aortitis (1) with stable maximal aortic wall thickness measured at 16 mm and axial diameter 38.5 mm with persistent retroperitoneal fibrosis (2). Left ureteric stent seen (3). Additional findings of a necrotic pancreatic head mass (4) and hypodense liver lesions (not visible in this cross-section).