Immunotherapy-Related Cystitis Induced by Nivolumab for Advanced Gastric Cancer: A Case Report

Area of Science:

• Oncology
• Immunology
• Urology

Background:

• Advanced gastric cancer treatment often involves combination chemotherapy and immunotherapy.
• Nivolumab, an immune checkpoint inhibitor, can cause immune-related adverse events.
• Cystitis is a potential side effect of cancer therapies, including immunotherapy.

Purpose of the Study:

• To report a case of immunotherapy-associated cystitis in a patient treated with nivolumab for advanced gastric cancer.
• To highlight the clinical presentation, diagnostic findings, and successful management of this adverse event.

Main Methods:

• A 70-year-old male patient with advanced gastric cancer received capecitabine, oxaliplatin, and nivolumab.
• Clinical symptoms, cystoscopy, computed tomography, and bladder biopsy were used for diagnosis.
• Treatment involved prednisolone for suspected immunotherapy-associated cystitis.

Main Results:

• The patient developed severe urethralgia and hematopyuria after four cycles of nivolumab therapy.
• Diagnostic investigations revealed cystitis with erosion, hemorrhage, and lymphocytic infiltration of the bladder mucosa.
• Symptoms significantly improved with prednisolone treatment.

Conclusions:

• Nivolumab therapy can induce cystitis as an immune-related adverse event in advanced gastric cancer patients.
• Early recognition and prompt treatment with corticosteroids are crucial for managing immunotherapy-associated cystitis.
• This case underscores the importance of monitoring for genitourinary side effects during nivolumab treatment.