Occult checkpoint inhibitor myocarditis during adjuvant nivolumab plus ipilimumab: a smoldering but severe toxicity

Immunotherapy. 2024;16(14-15):937-942. doi: 10.1080/1750743X.2024.2385286. Epub 2024 Sep 11.

Abstract

Checkpoint inhibitor myocarditis is a rare but life-threatening toxicity of immunotherapy, occasionally manifesting as persistent troponin elevation. Dual checkpoint blockade with ipilimumab and nivolumab has been found to induce immune-related myocarditis in patients with metastatic melanoma. We herein report a case of smoldering immune-related myocarditis in a 54-year-old male after a single infusion of nivolumab plus ipilimumab as adjuvant treatment for completely resected stage IV melanoma. High-dose steroid treatment resulted in decrease in the levels of cardiac enzymes, without any major complications.

Keywords: immune-related; immunotherapy; ipilimumab; melanoma; myocarditis; nivolumab; steroid treatment; toxicity.

Plain language summary

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Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols* / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
  • Chemotherapy, Adjuvant
  • Humans
  • Immune Checkpoint Inhibitors* / adverse effects
  • Immune Checkpoint Inhibitors* / therapeutic use
  • Ipilimumab* / administration & dosage
  • Ipilimumab* / adverse effects
  • Ipilimumab* / therapeutic use
  • Male
  • Melanoma* / drug therapy
  • Middle Aged
  • Myocarditis* / chemically induced
  • Nivolumab* / administration & dosage
  • Nivolumab* / adverse effects
  • Nivolumab* / therapeutic use
  • Skin Neoplasms / drug therapy
  • Skin Neoplasms / pathology

Substances

  • Ipilimumab
  • Nivolumab
  • Immune Checkpoint Inhibitors