A Case of Steroid-Dependent Immune Checkpoint Inhibitor Pneumonitis Treated With Subcutaneous Tocilizumab

A 57-year-old male with a history of urothelial cancer status post neoadjuvant cisplatin and gemcitabine, cystoprostatectomy and adjuvant nivolumab developed immune checkpoint inhibitor pneumonitis (ICI-p) following nivolumab treatment. He was treated with steroids but developed recurrent ICI-p during multiple steroid tapers. Given accumulating side effects from prolonged steroid treatment and the desire to minimise frequent visits to the clinic and infusion center, tocilizumab, which can be administered subcutaneously at home, was considered for steroid-dependent pneumonitis. Ultimately, he received intravenous followed by subcutaneous tocilizumab, and after a few months of treatment, he was weaned off steroids with sustained resolution of ICI-p, had improvement in steroid-related side effects, and had no progression or recurrence of his underlying bladder cancer. To our knowledge, this is the first case of subcutaneous tocilizumab being utilised for steroid-dependent ICI-p.