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━━ Background. Active hemorrhage due to multiple intestinal metastases from lung cancer is difficult to control. We herein report a case of hemorrhagic metastasis in the small intestine, in which hemostasis was successfully by nivolumab treatment. Case. A 62-year-old woman was referred to our department with fever and right chest and back pain. Chest CT demonstrated a mass of 9 cm in size in the right upper lobe of the lung. CTguided biopsy revealed squamous cell carcinoma. PET/CT visualized two sites of intestinal metastasis. As chemotherapy with carboplatin plus S1 was introduced, tarry stool and progressive anemia occurred. Endoscopy showed two hemorrhagic tumors in the proximal intestine. The biopsy also revealed evidence of squamous cell carcinoma. However, endoscopic hemostasis could not be obtained. Chemotherapy was ceased and surgery and interventional embolization were planned but were not performed because of the risk. Nivolumab therapy was started. Three weeks later, the patient’s tarry stool disappeared and her anemia improved. Chest CT performed 6 weeks later, showed the shrinkage of the main lung tumor. Conclusion. The anti-cancer effect of immune checkpoint inhibitors is mainly due to inflammatory changes such as fibrosis and granulation that occur due to the evoked immune response, while cytotoxic agents mainly exert their effects by directly necrotizing the tumor tissue. Thus, immune checkpoint inhibitors may stop bleeding in patients with hemorrhagic intestinal metastasis, without evoking severe necrosis or perforation. (JJLC. 2018;58:349-355)

Successful Hemostasis by Nivolumab in a Patient with Active Intestinal Bleeding from Metastatic Squamous Cell Carcinoma of the Lung