Two primary cancers appeared after discontinuation of nivolumab in the course of treating Hodgkin lymphoma - a case report

Sep 24, 2026

Immune checkpoint inhibitor therapy with nivolumab was discontinued in a 75-year-old man with relapse-refractory nodular sclerosis Hodgkin lymphoma after prior partial response on treatment. Weeks later, new suspicious lesions developed on the right earlobe and base of the tongue and were diagnosed pathologically as Merkel cell carcinoma and oropharyngeal squamous cell carcinoma. This case highlights immune checkpoint blockade’s broader anti-tumor activity and the potential emergence of additional malignancies shortly after discontinuation in high-risk patients.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Case Report Two primary cancers appeared after discontinuation of nivolumabin the course of treating Hodgkin lymphoma: a case report Lakshmi Bhavani Potluri1^, Sushmitha Nanjareddy1, Ali Al Sbihi2, Nouraldeen Manasrah1, William Smith IV3, Dahlia Sano4 1Department of Internal Medicine at Detroit Medical Center/Wayne State University, Sinai Grace Hospital, Detroit, MI, USA; 2Department of Internal Medicine at St. Mary Mercy Hospital, Livonia, MI, USA; 3Department of Pathology, Detroit Medical Center/Wayne State University, Detroit, MI, USA; 4Department of Oncology, University of Michigan, Ann Arbor, MI, USA Contributions: (I) Conception and design: LB Potluri, S Nanjareddy, A Al Sbihi, D Sano; (II) Administrative support: D Sano; (III) Provision of study materials or patients: D Sano; (IV) Collection and assembly of data: LB Potluri, S Nanjareddy, A Al Sbihi, N Manasrah, W Smith 4th; (V) Data analysis and interpretation: LB Potluri, S Nanjareddy, A Al Sbihi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Lakshmi Bhavani Potluri, MD. Department of Internal Medicine at Detroit Medical Center/Wayne State University, Sinai Grace Hospital, 6071 West Outer Drive, Detroit, MI 48235, USA. Email: [lpotluri@dmc.org](lpotluri@dmc.org). Background: Nivolumab is a human monoclonal antibody against programmed death-1 (PD-1) that blocks interactions of PD-1 with both PD-L1 and PD-L2 and upregulates tumor antigen-specific T cell to develop appropriate immune response against cancer cells. It has been approved by the US Food and Drug Administration (FDA) in the treatment of various malignancies including Hodgkin lymphoma (HL) . Case Description: Our patient is a 75-year-old man diagnosed with nodular sclerosis HL. After relapse of disease on several lines of treatment including autologous stem cell transplant, Nivolumab was started as part of a clinical trial. Partial response (PR) was noted on nivolumab for a few years which was eventually discontinued due to disease progression. A few weeks later, the patient was noted to have a suspicious lesion on the right earlobe and another on the base of the tongue, which were pathologically diagnosed as Merkel cell carcinoma (MCC) and oropharyngeal squamous cell carcinoma (SCC), respectively. Conclusions: Immune checkpoint inhibitors (ICIs) like nivolumab have demonstrated anti-tumor efficacy in several cancers to date. We describe here a unique observation of nivolumab suppressing the growth of two separate malignancies apart from the primary malignancy, discontinuation of which has then contributed to their growth and subsequent diagnosis. Our case report showcases the broad activity of ICIs and brings attention to the possibility of uncovering new malignancies after discontinuation of ICIs in high-risk patients. Keywords: Nivolumab; Hodgkin lymphoma (HL); discontinuation; Merkle cell carcinoma; case report Received: 04 November 2022; Accepted: 25 June 2023; Published online: 10 July 2023. doi: 10.21037/acr-22-87 View this article at: [https://dx.doi.org/10.21037/acr-22-87](https://dx.doi.org/10.21037/acr-22-87) Introduction The discovery of immune checkpoint proteins such as programmed death-1 (PD-1)/PD-L1 and CTLA-4 has revolutionized the field of cancer immunotherapy (1) . Immune checkpoint inhibitors (ICIs) against these proteins, block signaling through the PD-1 pathway, release inhibition of T cells, and augment antitumor immune responses. Nivolumab is one such humanized IgG4 ^ ORCID: 0000-0002-8419-2657. © AME Case Reports. All rights reserved. AME Case Rep 2023;7:30 | [https://dx.doi.org/10.21037/acr-22-87](https://dx.doi.org/10.21037/acr-22-87) Page 2 of 7 AME Case Reports, 2023 monoclonal anti-PD-1 antibody approved by the US Food and Drug Administration (FDA) in metastatic melanoma, renal cell carcinoma, gastric or gastroesophageal junction cancer, hepatocellular, classical Hodgkin’s lym

FAQs

What happened after nivolumab was discontinued in this patient?

After discontinuation of nivolumab, new lesions appeared within weeks, leading to diagnoses of Merkel cell carcinoma and oropharyngeal squamous cell carcinoma.

Which cancers were diagnosed in addition to Hodgkin lymphoma?

The patient was diagnosed with Merkel cell carcinoma (on the right earlobe) and oropharyngeal squamous cell carcinoma (at the base of the tongue).

Why is this case considered notable?

It suggests a unique suppressive effect of nivolumab on two separate malignancies in addition to the primary Hodgkin lymphoma, and shows malignancies emerging after stopping therapy.

Sep 24, 2026

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