Late-onset pericardial tamponade, bilateral pleural effusions and recurrent immune monoarthritis induced by ipilimumab use for metastatic melanoma

Abstract

While an important agent in the contemporary anti-melanoma armamentarium, ipilimumab is associated with serious immune reactions including late immune-mediated side effects. Recently, a case of late-onset acute pericarditis with tamponade was reported at 12 weeks after the last dose of ipilimumab. While polyarthralgia rheumatica has been previously documented with ipilimumab, we were not able to find any reports of recurrent monoarthritis with the use of this agent. Therefore, we present herein a unique case featuring a patient with late-onset autoimmune pleuropericarditis leading to cardiac tamponade at 24 weeks post-ipilimumab and recurrent late immune knee arthritis at 8 and 32 weeks, respectively. Furthermore, this late-onset toxicity seen with ipilimumab might also be expected with the PD1 inhibitors currently in clinical use. Timely diagnosis and prompt steroid use are crucial to ensure favorable clinical outcomes in these patients.

Non‐parallel anti‐tumour effects of pembrolizumab: a case of cardial tamponade

“…In these cases, pericardial fluid cytology showed a lymphocytic predominance, with no evidence of malignancy. Pericardial tissue biopsy revealed acute inflammation, suggesting that ICIs induced acute immune‐related pericarditis and pericardial effusion . Most of these cases occurred within three months after the initiation of therapy and subsequent steroid therapy was reported to be effective.…”

Breakthroughs in modern cancer therapy and elusive cardiotoxicity: Critical research‐practice gaps, challenges, and insights

“…Thus, serious side effects such as cardiotoxicity are still being documented. Nevertheless, clinical cardiotoxicity induced by ICIs and CART have been reported (Table ).…”

“…To date, FDA‐approved ICIs include Ipilimumab (CTLA‐4), Pembrolizumab (PD‐1), Nivolumab (PD‐1), Atezolizumab (PD‐L1), Avelumab (PD‐L1), and Durvalumab (PD‐L1). Based on the working principles, ICI‐induced toxicity typically involves autoimmune disorders, including autoimmune myocarditis . The importance of ICIs in the heart has been addressed in preclinical data, and the data give some mechanistic insights into the clinical observations of autoimmune myocarditis .…”

“…Based on the working principles, ICI-induced toxicity typically involves autoimmune disorders, 28,54,555,557,559 including autoimmune myocarditis. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]93,550 The importance of ICIs in the heart has been addressed in preclinical data, and the data give some mechanistic insights into the clinical observations of autoimmune myocarditis. 560,561 In addition, although ICIs are an attractive concept in the therapeutic development of cancer treatment, many cancer patients do not respond to treatments with ICIs, partly because of the lack of tumor-infiltrating effector T cells [562][563][564][565] or primary or acquired resistance due to various mechanisms.…”

“…VEGFR Colorectal Cancer, RCC SR4, 7,9,10,16,25,27,40,102,103,110 Vectibix [7][8][9][10]12,16,25,27,31,35,40,42,102,103,[115][116][117][118][119] Xgeva complications now threaten to offset some of the favorable benefits of these novel cancer treatments in cancer-related survival and strongly impact the quality of life regardless of the oncologic prognosis. [75][76][77] Additionally, effective clinical management remains quite challenging because no evidence-based approaches are currently available for the effective monitoring and treatment of these patients.…”