Acute autoimmune myocarditis and hepatitis due to ipilimumab monotherapy for malignant melanoma

Abstract

An important agent in melanoma therapy, ipilimumab is associated with autoimmune toxicity. Two cases of autoimmune pericarditis and large pericardial effusion have been documented with its use. Reports of myocardial toxicity have surfaced with this agent, mainly when used in combination with PD1 blockade. We present herein a case of autoimmune myocarditis leading to biventricular failure after four doses of IV ipilimumab 3 mg/kg as a single agent. Furthermore, this toxic effect may be anticipated with PD1 inhibitors. Increased clinical suspicion, prompt diagnosis, and steroid therapy are crucial to ensure a favorable clinical outcome.

Immune Checkpoint Inhibitor-Associated Cardiotoxicity: Current Understanding on Its Mechanism, Diagnosis and Management

“…As for the presentation of myocarditis, it is highly variable and nonspecific ( Table 1 ). Based on previously published studies, the manifestations of cardiotoxicity range from subclinical disease with asymptomatic cardiac biomarker elevation, fatigue, and general malaise to chest pain, dyspnea, palpitations, multiorgan failure, cardiogenic shock, and cardiac arrest (Laubli et al, 2015; Yun et al, 2015; Gibson et al, 2016; Escudier et al, 2017; Reuben et al, 2017; Mahmood et al, 2018a; Neilan et al, 2018; Wang et al, 2018; Samara et al, 2019).…”

A case of sustained ventricular tachycardia due to pembrolizumab

“…This was because the ventricular tachycardia in our patient was suppressed by steroid pulse therapy, which was initiated as a diagnostic therapy. Indeed, Samara and colleagues 8 previously reported the usefulness of steroid therapy in cases involving immune checkpoint inhibitor–induced autoimmune myocarditis.…”

Heart failure in cancer: role of checkpoint inhibitors

“…Takotsubo-like syndrome was also reported in a patient with metastatic melanoma after receiving four doses of Ipilimumab, suggesting that autoimmune myocarditis triggered by anti-CTLA-4 treatment could be a cause of apical ballooning and cardiomyopathy (35). The same dose regimen was also found to induce acute myocarditis in patient with malignant melanoma, which lead to biventricular failure (36).…”