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Lethal Immune Myocarditis and Myasthenia Gravis Due to Anti-PD-1 Treatment for a Bladder Cancer Patient: A Case
Pan Gao1,2, Xinyu Li1,2, Ziqiu He1,2
1Department of Urology, Second People's Hospital of Yichang, Yichang, Hubei Province, People's Republic of China.
Abstract:
Immune checkpoint inhibitors (ICI) have become a new hope for many patients with advanced cancer by blocking tumor immune escape. Bladder cancer is a common malignant tumor of the urinary tract epithelium that often relapses and metastasizes after surgery, chemotherapy, and radiotherapy. Immunotherapy has dramatically improved patient survival rates and clinical benefits as a new, potentially effective therapy. However, avoidance of various immune-related adverse events (irAEs) remains an implausible idea. ICI-induced myocarditis is different from viral myocarditis, and mortality is still high with the current treatment. We report the case of an 82-year-old female patient with ICI-induced fulminant myocarditis and myasthenia gravis. Although she actively accepted the current mainstream treatment for immune-related myocarditis and myasthenia, she died of heart and respiratory failure. Analyzing and reporting the patient's disease development process and the changes in related indicators may help peers gain a deeper understanding of immune-related adverse events and reduce the mortality of immune-related myocarditis.
Insights
Immune checkpoint inhibitors (ICI) offer cancer treatment hope but can cause severe immune-related adverse events (irAEs). This case highlights the high mortality of ICI-induced myocarditis, even with treatment.
Area of Science:
- Oncology
- Immunology
- Cardiology
Background:
- Immune checkpoint inhibitors (ICIs) are revolutionizing cancer therapy by overcoming tumor immune evasion.
- Bladder cancer frequently recurs and metastasizes, necessitating advanced treatment strategies.
- Immunotherapy, including ICIs, offers significant clinical benefits but is associated with immune-related adverse events (irAEs).
Observation:
- A rare case of fulminant myocarditis and myasthenia gravis induced by ICIs in an 82-year-old female patient.
- The patient received standard treatments for immune-related myocarditis and myasthenia gravis.
- Despite aggressive management, the patient succumbed to cardiorespiratory failure.
Findings:
- ICI-induced myocarditis presents distinct characteristics compared to viral myocarditis.
- Mortality rates for ICI-induced myocarditis remain high despite current therapeutic interventions.
- This case underscores the critical challenges in managing severe irAEs associated with immunotherapy.
Implications:
- Detailed analysis of this case may enhance understanding of ICI-induced myocarditis and myasthenia gravis.
- Improved recognition and management strategies for irAEs could potentially reduce mortality.
- Further research is needed to develop more effective treatments for ICI-related cardiotoxicity.
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