Immune checkpoint inhibitors (ICIs) have transformed the treatment in
malignancies because of the impact on reactivating the immune cells to kill
tumor cells. Because anti-CTLA-4 antibody and anti-PD-1 antibody (or anti-PD-L1 antibody) work in different ways, they have synergistic effects when used in combination in many
cancers. However, it has been found that a strong immune response may lead to more serious and multi-system immune-related adverse events (irAE). We describe an advanced
esophageal squamous cell carcinoma patient who received
nivolumab combined with
ipilimumab resulting in
hypophysitis and immune-mediated liver injury. He was enrolled into a CheckMate 648 global, multicenter, randomized phase 3 Clinical Trial (CTR20171227) investigating the combined potency of
nivolumab and
ipilimumab in the treatment of patients with advanced
esophageal squamous cell carcinoma and admitted to our center (site 0200). The patient developed
hypophysitis and immune-related
hepatitis rapidly after ICIs
therapy, leading to the interruption of anti-
tumor therapy. Then the patient developed
Herpes zoster and recurrence of
tuberculosis after treatment of irAEs with
glucocorticoids. We report this case in the hope that doctors need to have sufficient knowledge and attention to the occurrence of irAE during the anti-immune combination
therapy and actively intervene as soon as possible to obtain better anti-
tumor effects and less harm to patients.