Case Report: Immunotherapy-induced myocarditis requiring pacemaker insertion in an older adult. what happens if we rechallenge?

Le résumé fourni par la source

Immune checkpoint inhibitors (ICIs) have revolutionized the practice of oncology, becoming a cornerstone treatment for many cancers. Nivolumab, an antibody-targeting programmed cell death protein-1 (PD-1), and ipilimumab, an antibody-targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), are two ICIs that, when combined, lead to improved treatment responses and enhanced survival rates. However, dual immunotherapy can come at the expense of increased incidence of autoimmune-related adverse events. The mortality rate of ICI-induced myocarditis can be high, and therapy rechallenge can pose a significant risk of recurrence and severe complications. There is no consensus regarding therapy rechallenge after myocarditis, and this decision should be made in a multidisciplinary discussion following a patient-centered approach. In our paper, we report the case of an adult patient with metastatic renal cell carcinoma who developed multiorgan toxicity, including severe myocarditis that required pacemaker implantation, after a single cycle of ipilimumab and nivolumab. Importantly, we also report the consequences on her cardiac and safety profile following ICI rechallenge.

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