Skip to main content
SpringerLink
Log in

An autopsy case of lung adenocarcinoma with immune checkpoint inhibitor-induced pneumonia and fulminant myocarditis following pembrolizumab administration: a case report

  • Case report - Complication
  • Published:
International Cancer Conference Journal Aims and scope Submit manuscript

Abstract

Immune checkpoint inhibitors (ICIs) are the current standard of care for non-small-cell lung cancer (NSCLC). Myocarditis is a rare but serious immune-related adverse event (irAE) associated with ICI therapy. We present a patient who received a single dose of pembrolizumab for NSCLC and developed ICI-associated pneumonia. Although pneumonia improved with corticosteroid therapy, the patient subsequently developed ICI-associated fulminant myocarditis. Despite high-dose corticosteroid therapy, the patient died on day 30 after pembrolizumab initiation. Even if an observed irAE was effectively treated, clinicians should remain vigilant for other irAEs, especially those that are difficult to control with low-dose corticosteroids.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and materials

Not applicable.

References

  1. Brahmer J, Reckamp KL, Baas P et al (2015) Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med 373:123–135

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Borghaei H, Paz-Ares L, Horn L et al (2015) Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med 373:1627–1639

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Herbst RS, Baas P, Kim DW et al (2016) Pembrolizumab versus docetaxel for previously treated, PD-L1- positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet 387:1540–1550

    Article  CAS  PubMed  Google Scholar 

  4. Felip E, Altorki N, Zhou C et al (2021) Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010): a randomised, multicentre, open-label, phase 3 trial. Lancet 398:1344–1357

    Article  CAS  PubMed  Google Scholar 

  5. Johnson DB, Balko JM, Compton ML et al (2016) Fulminant myocarditis with combination immune checkpoint blockade. N Engl J Med 375:1749–1755

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wang DY, Salem JE, Cohen JV et al (2018) Fatal toxic effects associated with immune checkpoint inhibitors: a systematic review and meta-analysis. JAMA Oncol 4:1721–1728

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mahmood SS, Fradley MG, Cohen JV et al (2018) Myocarditis in patients treated with immune checkpoint inhibitors. J Am Coll Cardiol 71:1755–1764

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Salem JE, Manouchehri A, Moey M et al (2018) Cardiovascular toxicities associated with immune checkpoint inhibitors: an observational, retrospective, pharmacovigilance study. Lancet Oncol 19:1579–1589

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kindermann I, Barth C, Mahfoud F et al (2012) Update on myocarditis. J Am Coll Cardiol 59:779–792

    Article  PubMed  Google Scholar 

  10. Hu JR, Florido R, Lipson EJ et al (2019) Cardiovascular toxicities associated with immune checkpoint inhibitors. Cardiovasc Res 115:854–868

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Shannon VR, Anderson R, Blidner A et al (2020) Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune-related adverse events: pulmonary toxicity. Support Care Cancer 28:6145–6157

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lyon AR, Yousaf N, Battisti NML et al (2018) Immune checkpoint inhibitors and cardiovascular toxicity. Lancet Oncol 19:e447–e458

    Article  CAS  PubMed  Google Scholar 

  13. Palaskas N, Lopez-Mattei J, Durand JB et al (2020) Immune checkpoint inhibitor myocarditis: pathophysiological characteristics, diagnosis, and treatment. J Am Heart Assoc 9:e013757

    Article  PubMed  PubMed Central  Google Scholar 

  14. Arangalage D, Delyon J, Lermuzeaux M et al (2017) Survival after fulminant myocarditis induced by immune-checkpoint inhibitors. Ann Intern Med 167:683–684

    Article  PubMed  Google Scholar 

  15. Esfahani K, Buhlaiga N, Thébault P et al (2019) Alemtuzumab for immune-related myocarditis due to PD-1 therapy. N Engl J Med 380:2375–2376

    Article  PubMed  Google Scholar 

  16. Salem JE, Allenbach Y, Vozy A et al (2019) Abatacept for severe immune checkpoint inhibitor-associated myocarditis. N Engl J Med 380:2377–2379

    Article  PubMed  Google Scholar 

  17. Pathak R, Katel A, Massarelli E et al (2021) Immune checkpoint inhibitor-induced myocarditis with myositis/myasthenia gravis overlap syndrome: a systematic review of cases. Oncologist 26:1052–1061

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank Editage (www.editage.com) for the English language editing.

Funding

This study did not receive any specific grants from funding agencies in the public, commercial, or non-profit sectors.

Author information

Authors and Affiliations

  1. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8560, Japan

    Takahiko Hashimoto

  2. Department of Respiratory Medicine, Anjo Kosei Hospital, 28 Higashihirokute, Anjo-Cho, Anjo, Aichi, 446-8602, Japan

    Kosuke Takahashi, Haruka Kondo & Toru Hara

  3. Department of Respiratory Medicine, Toyota Kosei Hospital, Aichi, Japan

    Kosuke Ito

  4. Department of Respiratory Medicine, Toyota Memorial Hospital, Aichi, Japan

    Kahori Iwade

  5. Department of Respiratory Medicine, Kariya Toyota General Hospital, Aichi, Japan

    Atsushi Torii

  6. Department of Thoracic Surgery, Komaki City Hospital, Aichi, Japan

    Minoru Sugihara

Authors
  1. Takahiko Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kosuke Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kosuke Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kahori Iwade
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atsushi Torii
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Minoru Sugihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Haruka Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Toru Hara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kosuke Takahashi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent is obtained from the patient.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hashimoto, T., Takahashi, K., Ito, K. et al. An autopsy case of lung adenocarcinoma with immune checkpoint inhibitor-induced pneumonia and fulminant myocarditis following pembrolizumab administration: a case report. Int Canc Conf J (2024). https://doi.org/10.1007/s13691-024-00665-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13691-024-00665-7

Keywords

Search

Navigation