Immune-related myositis resulting from combination therapy of ipilimumab and nivolumab in patient with metastatic renal cell carcinoma

• Published in: BMJ case reports 2020-09, Vol.13 (9), p.e235199
• Main Authors: Okubo, Naoya, Kijima, Toshiki, Nukui, Akinori, Kamai, Takao
• Format: Article
• Language: English
• Subjects: Antibodies; Antineoplastic Agents, Immunological - administration & dosage; Antineoplastic Agents, Immunological - adverse effects; Antineoplastic Agents, Immunological - immunology; Autoimmune diseases; Biopsy; Bone Neoplasms - diagnosis; Bone Neoplasms - secondary; Cancer therapies; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - physiopathology; Carcinoma, Renal Cell - therapy; Case reports; Combination therapy; Creatinine; Diabetes; Diagnosis, Differential; Eye movements; Humans; Immune Checkpoint Inhibitors - administration & dosage; Immune Checkpoint Inhibitors - adverse effects; Immune Checkpoint Inhibitors - immunology; Immunologic Tests - methods; Immunotherapy; Inflammation; Inflammatory diseases; Ipilimumab - adverse effects; Ipilimumab - immunology; Kidney cancer; Kinases; Laboratories; Lung Neoplasms - diagnosis; Lung Neoplasms - secondary; Lymphatic system; Male; Medical imaging; Medical prognosis; Metastasis; Middle Aged; Monoclonal antibodies; Movement disorders; Musculoskeletal diseases; Myasthenia gravis; Myositis - etiology; Myositis - immunology; Myositis - therapy; Neoplasm Staging; Nephrectomy - methods; Nivolumab - administration & dosage; Nivolumab - adverse effects; Nivolumab - immunology; Patient Care Management - methods; Patients; Targeted cancer therapy; Tomography, X-Ray Computed - methods; Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions; urinary and genital tract disorders; Urological cancer; urological surgery
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-235199

Immune-related myositis is one of the rare immune-related adverse events whose underlying precise mechanisms are not fully understood. Here, we describe a case of immune-related myositis that developed after four cycles of combination therapy with nivolumab plus ipilimumab for the treatment of metastatic renal cell carcinoma. Negative results of autoimmune antibodies, including anti-acetylcholine receptor and anti-muscle-specific kinase antibodies suggested a T-cell-mediated mechanism. After recovery with steroid therapy, the patient resumed nivolumab monotherapy and survived without any evidence of disease progression or refractory of myositis. Differential diagnosis between T-cell-mediated and B-cell-mediated immune-related myositis and its impact on optimal management are discussed.