Introduction
Nivolumab, an anti-programmed death-1 (PD-1) antibody, is an immune checkpoint inhibitor. According to the results of the CheckMate-141 study, which compared nivolumab and a physician-selected treatment modality for recurrent/metastatic head and neck squamous cell carcinoma with a history of chemotherapy including platinum, nivolumab significantly increases the overall survival rate1. Considering the results of this report, nivolumab was approved in the United States in November 2016 and in Japan in March 2017 as a treatment modality for patients with recurrent/metastatic head and neck cancer, who had been previously treated with platinum-containing drugs. Currently, the clinical benefits of nivolumab therapy have been recognized not only in head and neck cancers but also in other types of cancers such as malignant melanoma, non-small cell lung cancer, renal cell cancer, gastric cancer, and Hodgkin’s lymphoma. Various immune-related adverse events associated with nivolumab have been reported, because the mechanism of action of the drug is different from that of conventional anticancer drugs. However, the frequency of severe skin complications is considerably less.
Toxic epidermal necrosis (TEN) is a disease with fever and widespread erythema, erosion, blisters, mucosal rash on the skin. TEN is a rare, albeit serious disease with a mortality rate of approximately 30%2. We herein report a patient with squamous cell carcinoma of the tongue who developed TEN after nivolumab treatment.