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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.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/two-primary-cancers-appeared-after-discontinuation-of-nivolumab-in-the-course-of-treating-hodgkin-lymphoma-a-case-report/380204/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/two-primary-cancers-appeared-after-discontinuation-of-nivolumab-in-the-course-of-treating-hodgkin-lymphoma-a-case-report/380204.png","ImageObject",300,407,{"name":92,"@type":93},"WPS_1786070896","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What happened after nivolumab was discontinued in this patient?","Question",{"text":113,"@type":114},"After discontinuation of nivolumab, new lesions appeared within weeks, leading to diagnoses of Merkel cell carcinoma and oropharyngeal squamous cell carcinoma.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which cancers were diagnosed in addition to Hodgkin lymphoma?",{"text":118,"@type":114},"The patient was diagnosed with Merkel cell carcinoma (on the right earlobe) and oropharyngeal squamous cell carcinoma (at the base of the tongue).",{"name":120,"@type":111,"acceptedAnswer":121},"Why is this case considered notable?",{"text":122,"@type":114},"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.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},380204,1790296898,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},549768072016,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Case Report  \nTwo primary cancers appeared after discontinuation of nivolumabin the course of treating Hodgkin lymphoma: a case report  \nLakshmi Bhavani Potluri1^, Sushmitha Nanjareddy1, Ali Al Sbihi2, Nouraldeen Manasrah1, William Smith IV3, Dahlia Sano4  \n1Department 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  \nContributions: (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.  \nCorrespondence to: Lakshmi Bhavani Potluri, MD. Department of Internal Medicine at Detroit Medical Center/Wayne State University, Sinai Grace  \nHospital, 6071 West Outer Drive, Detroit, MI 48235, USA. Email: [lpotluri@dmc.org](lpotluri@dmc.org).  \nBackground: 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  \nAdministration (FDA) in the treatment of various malignancies including Hodgkin lymphoma (HL) .  \nCase 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  \ncell carcinoma (MCC) and oropharyngeal squamous cell carcinoma (SCC), respectively.  \nConclusions: 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  \npatients.  \nKeywords: Nivolumab; Hodgkin lymphoma (HL); discontinuation; Merkle cell carcinoma; case report  \nReceived: 04 November 2022; Accepted: 25 June 2023; Published online: 10 July 2023.  \ndoi: 10.21037/acr-22-87  \nView this article at: [https://dx.doi.org/10.21037/acr-22-87](https://dx.doi.org/10.21037/acr-22-87)  \nIntroduction  \nThe 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) .  \nImmune 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  \n^ ORCID: 0000-0002-8419-2657.  \n© 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)  \nPage 2 of 7 AME Case Reports, 2023  \nmonoclonal 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","cbCaidX169uXDxBx","https://ap.wps.com/l/cbCaidX169uXDxBx","pdf",648748,"English","# Case Description\n## Conclusions and highlight box\n# Introduction\n## Background on nivolumab and immune checkpoint inhibitors\n# Highlight box\n## Key findings\n## What is known and what is new","[{\"question\":\"What happened after nivolumab was discontinued in this patient?\",\"answer\":\"After discontinuation of nivolumab, new lesions appeared within weeks, leading to diagnoses of Merkel cell carcinoma and oropharyngeal squamous cell carcinoma.\"},{\"question\":\"Which cancers were diagnosed in addition to Hodgkin lymphoma?\",\"answer\":\"The patient was diagnosed with Merkel cell carcinoma (on the right earlobe) and oropharyngeal squamous cell carcinoma (at the base of the tongue).\"},{\"question\":\"Why is this case considered notable?\",\"answer\":\"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.\"}]","Two primary cancers appeared after discontinuation of nivolumab in the course of treating Hodgkin lymphoma - a case report | PDF",1790239195,18]