Researchers looked at the case of an 85-year-old male with Muir-Torre syndrome, who had a history of various cancers and an MSH2 gene mutation. Diagnosed with gastric adenocarcinoma, he began pembrolizumab immunotherapy but experienced severe chest pain and shortness of breath after the second dose. Investigations indicated that grade 4 myocarditis was linked to the treatment, along with signs of myositis and potential hepatitis.

The patient was treated with corticosteroids and infliximab for myocarditis, and later resumed therapy with a reduced dose of nivolumab, achieving complete response in a year. This case highlights the critical need for careful risk-benefit analysis and shared decision-making in rechallenging patients with severe immune-related adverse events from immune checkpoint inhibitors.

Reference: Eslinger C, Walden D, Barry T, Shah S, Samadder NJ, Bekaii-Saab TS. Rechallenge With Switching Immune Checkpoint Inhibitors Following Autoimmune Myocarditis in a Patient With Lynch Syndrome. J Natl Compr Canc Netw. 2023;21(9):894-899. doi:10.6004/jnccn.2023.7029