What happened, in summary

A 68-year-old man had been diagnosed with stage IV gastric cancer 11 months before a hospital admission. He first received 6 months of S-1, a combination of tegafur, gimeracil, and oteracil, with oxaliplatin. He then received paclitaxel and ramucirumab for 3 months, but neither regimen produced much benefit. Nivolumab was started at 3 mg/kg every 2 weeks.

Within 2 months of starting nivolumab, urine testing showed increasing protein and blood. He lost 3 kg, developed diarrhea, and his creatinine rose from 0.77 to 1.96 mg/dL. A kidney biopsy showed glomerular endothelial injury. Nivolumab was stopped. Steroids were not used because dehydration was also thought to contribute and the biopsy changes were not severe.

His kidney function gradually improved, and proteinuria disappeared about 6 weeks after nivolumab was stopped. Because the cancer had progressed, nivolumab was restarted, but it was ineffective. His oncologist then changed treatment to irinotecan. Blood in the urine eventually resolved 7 months after the final nivolumab dose.