What are the consequences on the cardiac and safety profile following immune checkpoint inhibitor rechallenge in a patient who previously developed severe ICI-induced myocarditis?
This case report explores the feasibility and safety of rechallenging a patient with immune checkpoint inhibitors after a severe episode of ICI-induced myocarditis requiring pacemaker implantation.
Immune checkpoint inhibitors (ICIs) have revolutionized the practice of oncology, becoming a cornerstone treatment for many cancers. Nivolumab, an antibody-targeting programmed cell death protein-1 (PD-1), and ipilimumab, an antibody-targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), are two ICIs that, when combined, lead to improved treatment responses and enhanced survival rates. However, dual immunotherapy can come at the expense of increased incidence of autoimmune-related adverse events. The mortality rate of ICI-induced myocarditis can be high, and therapy rechallenge can pose a significant risk of recurrence and severe complications. There is no consensus regarding therapy rechallenge after myocarditis, and this decision should be made in a multidisciplinary discussion following a patient-centered approach. In our paper, we report the case of an adult patient with metastatic renal cell carcinoma who developed multiorgan toxicity, including severe myocarditis that required pacemaker implantation, after a single cycle of ipilimumab and nivolumab. Importantly, we also report the consequences on her cardiac and safety profile following ICI rechallenge.
Assaad et al. (2026) studied this question.