Background: Cytotoxic chemotherapy (cCT) for patients with advanced non-small cell lung cancer (NSCLC) as a second-line or subsequent treatment generally results in a poor treatment outcome. Several reports have indicated that subsequent cCT among patients who have received immune checkpoint inhibitors might have a relatively better efficacy. Methods: The clinical data of patients with advanced NSCLC treated with nivolumab were consecutively reviewed, and the treatment outcomes of subsequent cCTs following nivolumab were analyzed. Results: Among 170 advanced NSCLC patients treated with nivolumab, 113 patients discontinued nivolumab, and 29 patients received subsequent cCT. The patient characteristics were as follows: sex (male/female), 15/14; median age, 62 (range 42-79) years; histology, 24 adenocarcinoma, 4 squamous carcinoma, 1 NSCLC not otherwise specified; treatment line of nivolumab, 16 with second-line, 7 with third-line, 2 with fourthline, and 4 with more than fifth-line; subsequent chemotherapy following nivolumab, 10 with docetaxel þ/ramucirumab, 10 with TS-1, 3 with pemetrexed, 3 with gemcitabine, and 3 with others. Among the 21 evaluable patients treated with subsequent CT following nivolumab, 2 cases had partial response, 5 cases had stable disease, and 14 cases had progressive disease, resulting in an objective response rate (ORR) of 9.5%. Among the 9 evaluable patients treated with docetaxel þ/ramucirumab and the 13 evaluable patients treated with TS-1 in any line of treatment after nivolumab, the ORRs were 22.2% and 7.7%, respectively.
Background: A cholecystoduodenal fistula is often caused by gallstones, but rarely causes gastrointestinal bleeding. Interventional radiology or surgery is used when gastrointestinal bleeding is difficult to treat endoscopically, and interventional radiology has been increasingly performed in recent years. Case Report: We report a rare case of arterial bleeding caused by a dropped gallstone from a cholecystoduodenal fistula, with successful treatment using interventional radiology. Conclusion: Reports of gastrointestinal bleeding from an internal biliary fistula with successful treatment using interventional radiology are very rare. This case illustrates the effectiveness of interventional radiology for a rare case of arterial bleeding caused by a dropped gallstone from a cholecystoduodenal fistula.
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