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. 2016 Jun 21:4:36.
doi: 10.1186/s40425-016-0139-8. eCollection 2016.

Acute rhabdomyolysis with severe polymyositis following ipilimumab-nivolumab treatment in a cancer patient with elevated anti-striated muscle antibody

Mehmet Asim Bilen  1 , Sumit K Subudhi  2 , Jianjun Gao  2 , Nizar M Tannir  2 , Shi-Ming Tu  2 , Padmanee Sharma  2
Affiliations

Acute rhabdomyolysis with severe polymyositis following ipilimumab-nivolumab treatment in a cancer patient with elevated anti-striated muscle antibody

Mehmet Asim Bilen et al. J Immunother Cancer. .

Abstract

Background: Immune checkpoint inhibitors have revolutionized cancer therapy since these drugs target inhibitory pathways on T cells, which result in durable anti-tumor immune responses and significant overall survival for a subset of cancer patients. These drugs can also lead to toxicities, which require additional research to identify mechanisms of toxicities and biomarkers that can help to identify patients who will develop immune-related adverse events.

Case presentation: We describe the first case, to our knowledge, of a patient with metastatic urothelial carcinoma who developed acute rhabdomyolysis with severe polymyositis after treatment with combination immunotherapy consisting of ipilimumab plus nivolumab (Trial registration: NCT01928394. Registered: 8/21/2013). We found that this patient had an elevated pre-existing anti-striated muscle antibody titer, which was likely exacerbated with the immunotherapy treatment thereby resulting in the presentation of acute rhabdomyolysis and severe polymyositis.

Conclusions: This case suggests that immune-related adverse events may be linked to subclinical autoimmune conditions which highlights the need for additional studies to identify patients who are at risk for toxicities.

Keywords: Immune checkpoint inhibitors; Immune-related adverse event; Ipilimumab; Nivolumab; Polymyositis; Rhabdomyolysis; Urothelial carcinoma.

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Figures

Fig. 1
Fig. 1
Summary of the patient’s hospital stay including changes in laboratory results and treatment. Dotted lines indicate grade 3 adverse events according to the Common Terminology Criteria for Adverse Events, Version 4. AST indicates aspartate transaminase; ALT, alanine transaminase; CK-MB, creatinine kinase isoenzyme MB; CK, creatinine kinase; ULN, upper limit of normal; AE, adverse event; IPI, ipilimumab; NIVO, nivolumab; Trach, tracheostomy; IVIG, intravenous immunoglobulin
Fig. 2
Fig. 2
Negative CD3 staining of patient’s muscle biopsy, (20X)
See this image and copyright information in PMC

References

    1. Hodi FS, O'Day SJ, McDermott DF, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010;363(8):711–23. doi: 10.1056/NEJMoa1003466. - DOI - PMC - PubMed
    1. Robert C, Thomas L, Bondarenko I, et al. Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N Engl J Med. 2011;364(26):2517–26. doi: 10.1056/NEJMoa1104621. - DOI - PubMed
    1. Robert C, Long GV, Brady B, et al. Nivolumab in previously untreated melanoma without BRAF mutation. N Engl J Med. 2015;372(4):320–30. doi: 10.1056/NEJMoa1412082. - DOI - PubMed
    1. Brahmer J, Reckamp KL, Baas P, et al. Nivolumab versus Docetaxel in Advanced Squamous-Cell Non-Small-Cell Lung Cancer. N Engl J Med. 2015;373(2):123–35. doi: 10.1056/NEJMoa1504627. - DOI - PMC - PubMed
    1. Motzer RJ, Escudier B, McDermott DF, et al. Nivolumab versus Everolimus in Advanced Renal-Cell Carcinoma. N Engl J Med. 2015;373(19):1803–13. doi: 10.1056/NEJMoa1510665. - DOI - PMC - PubMed

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