Myocarditis with tremelimumab plus durvalumab combination therapy for endometrial cancer: A case report
Background: Fulminant myocarditis has been reported in patients treated with immune checkpoint inhibitors. We present the first described case of acute immune-mediated myocarditis and myositis associated with durvalumab plus tremelimumab combination therapy. The patient was undergoing treatment for...
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doaj-8f77b67a0be24fe9be462f7fa7e34faa2020-11-25T02:48:41ZengElsevierGynecologic Oncology Reports2352-57892018-08-01257477Myocarditis with tremelimumab plus durvalumab combination therapy for endometrial cancer: A case reportSyed S. Mahmood0Carol L. Chen1Natalie Shapnik2Udhay Krishnan3Harsimran S. Singh4Vicky Makker5Cardiology Division, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, United StatesCardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Medicine, Weill Cornell Medical College, New York, NY, United StatesGynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United StatesCardiology Division, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, United States; Department of Medicine, Weill Cornell Medical College, New York, NY, United StatesCardiology Division, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, United States; Department of Medicine, Weill Cornell Medical College, New York, NY, United StatesDepartment of Medicine, Weill Cornell Medical College, New York, NY, United States; Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Corresponding author at: Gynecologic Medical Oncologic Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.Background: Fulminant myocarditis has been reported in patients treated with immune checkpoint inhibitors. We present the first described case of acute immune-mediated myocarditis and myositis associated with durvalumab plus tremelimumab combination therapy. The patient was undergoing treatment for advanced endometrial cancer. Case presentation: A 75-year-old Caucasian female presented with difficulty ambulating due to neck protraction, imbalance, and increased shortness of breath with exertion 3 weeks after her first durvalumab and tremelimumab administration for advanced endometrial cancer. While the patient's initial laboratory data showed an acute transaminitis and elevated creatine phosphokinase (CPK), consistent with myositis, she developed complete heart block and ventricular dysfunction, with elevated troponins. Endomyocardial biopsy confirmed a diagnosis of immune-mediated myocarditis. She was treated with high-dose steroids and mycophenolate mofetil, which led to eventual native conduction and left ventricular ejection fraction recovery. Upon discharge, she was titrated off of steroids over 8 weeks and her mycophenolate was subsequently stopped. A follow-up computed tomography scan revealed progression of metastatic disease. The patient remains alive using supplemental oxygen 3 months after admission. Conclusions: Durvalumab plus tremelimumab combination therapy can lead to fulminant immune-mediated myocarditis. This patient's myocarditis was amenable to treatment with high-dose intravenous steroids and mycophenolate. Keywords: Endometrial cancer, Durvalumab, Tremelimumab, Immune-mediated myocarditis, Cardio-oncology, Myositishttp://www.sciencedirect.com/science/article/pii/S235257891830050X |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Syed S. Mahmood Carol L. Chen Natalie Shapnik Udhay Krishnan Harsimran S. Singh Vicky Makker |
spellingShingle |
Syed S. Mahmood Carol L. Chen Natalie Shapnik Udhay Krishnan Harsimran S. Singh Vicky Makker Myocarditis with tremelimumab plus durvalumab combination therapy for endometrial cancer: A case report Gynecologic Oncology Reports |
author_facet |
Syed S. Mahmood Carol L. Chen Natalie Shapnik Udhay Krishnan Harsimran S. Singh Vicky Makker |
author_sort |
Syed S. Mahmood |
title |
Myocarditis with tremelimumab plus durvalumab combination therapy for endometrial cancer: A case report |
title_short |
Myocarditis with tremelimumab plus durvalumab combination therapy for endometrial cancer: A case report |
title_full |
Myocarditis with tremelimumab plus durvalumab combination therapy for endometrial cancer: A case report |
title_fullStr |
Myocarditis with tremelimumab plus durvalumab combination therapy for endometrial cancer: A case report |
title_full_unstemmed |
Myocarditis with tremelimumab plus durvalumab combination therapy for endometrial cancer: A case report |
title_sort |
myocarditis with tremelimumab plus durvalumab combination therapy for endometrial cancer: a case report |
publisher |
Elsevier |
series |
Gynecologic Oncology Reports |
issn |
2352-5789 |
publishDate |
2018-08-01 |
description |
Background: Fulminant myocarditis has been reported in patients treated with immune checkpoint inhibitors. We present the first described case of acute immune-mediated myocarditis and myositis associated with durvalumab plus tremelimumab combination therapy. The patient was undergoing treatment for advanced endometrial cancer. Case presentation: A 75-year-old Caucasian female presented with difficulty ambulating due to neck protraction, imbalance, and increased shortness of breath with exertion 3 weeks after her first durvalumab and tremelimumab administration for advanced endometrial cancer. While the patient's initial laboratory data showed an acute transaminitis and elevated creatine phosphokinase (CPK), consistent with myositis, she developed complete heart block and ventricular dysfunction, with elevated troponins. Endomyocardial biopsy confirmed a diagnosis of immune-mediated myocarditis. She was treated with high-dose steroids and mycophenolate mofetil, which led to eventual native conduction and left ventricular ejection fraction recovery. Upon discharge, she was titrated off of steroids over 8 weeks and her mycophenolate was subsequently stopped. A follow-up computed tomography scan revealed progression of metastatic disease. The patient remains alive using supplemental oxygen 3 months after admission. Conclusions: Durvalumab plus tremelimumab combination therapy can lead to fulminant immune-mediated myocarditis. This patient's myocarditis was amenable to treatment with high-dose intravenous steroids and mycophenolate. Keywords: Endometrial cancer, Durvalumab, Tremelimumab, Immune-mediated myocarditis, Cardio-oncology, Myositis |
url |
http://www.sciencedirect.com/science/article/pii/S235257891830050X |
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