Immunotherapy: A Case Series

Immunotherapy is on the rise as a treatment option for advanced melanoma, non-small cell lung carcinoma, renal cell carcinoma, and melanoma among others. It consists of two main classes being cytotoxic T lymphocyte antigen 4 (CTLA 4) inhibitors and programmed cell death 1 (PD 1) inhibitors. We report a case series of four patients who were started on either pembrolizumab or nivolumab for the treatment of melanoma or lung cancer. While on immunotherapy, they developed various side effects related to the immunotherapy including pneumonitis, transaminitis, thyroiditis, nephritis, and hypophysitis. To treat this complication, immunotherapy must be discontinued or held with immunosuppressant initiation as treatment. Most often the immunosuppressant of choice is steroids. After symptoms improve, patients can decide along with the clinician on restarting or completely stopping immunotherapy. Within our case series, three of four patients had resolutions of their symptoms with steroid treatment with one who was lost to follow up. Of the three patients who were being followed up, one had a relapse of side effects after resuming immunotherapy and decided against further treatment with immunotherapy. Another patient is doing well resuming immunotherapy on a daily dose of steroids. The last patient decided to not continue with immunotherapy after experiencing a flare of his symptoms when he was being treated since he missed a few doses of steroids. Further research is needed about the risk of flares of complications when resuming immunotherapy alone or with immunotherapy and steroid treatment.