Multiorgan Toxicity from Dual Checkpoint Inhibitor Therapy, Resulting in a Complete Response-A Case Report

• Published in: Medicina (Kaunas, Lithuania) Vol. 60; no. 7; p. 1129
• Main Authors: Astašauskaitė, Skaistė, Kupčinskaitė-Noreikienė, Rita, Zaborienė, Inga, Vaičiūnienė, Rūta, Vanagas, Tomas, Pranys, Darius, Poškienė, Lina, Juozaitytė, Elona
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 12.07.2024
• Subjects: Biopsy; Blood tests; Cancer; Carcinoma, Renal Cell - drug therapy; Case reports; clear cell renal carcinoma; Colitis - chemically induced; complete response; Creatinine; CTLA-4 Antigen - antagonists & inhibitors; Cytotoxicity; Diarrhea; Disease; Drug dosages; Hemodialysis; Hepatitis; Humans; immune checkpoint inhibitor-induced colitis; immune checkpoint inhibitor-induced hepatitis; immune checkpoint inhibitors; Immune Checkpoint Inhibitors - adverse effects; immune-mediated nephritis; Immunotherapy; Inflammatory bowel disease; Kidney cancer; Kidney Neoplasms - drug therapy; Laparoscopy; Liver; Male; Metastasis; Middle Aged; Mortality; Myocarditis; Nonsteroidal anti-inflammatory drugs; Patients; Programmed Cell Death 1 Receptor - antagonists & inhibitors; Steroids; Toxicity; Treatment Outcome; immune checkpoint inhibitor-induced colitis; complete response; immune-mediated nephritis; immune checkpoint inhibitors; immune checkpoint inhibitor-induced hepatitis; clear cell renal carcinoma
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60071129

Immunotherapy treatment with checkpoint inhibitors (ICIs) has led to a breakthrough in the treatment of oncological diseases. Despite its clinical effectiveness, this treatment differs from others, such as cytotoxic chemotherapy, in that it causes immune-related adverse events. This type of toxicity can affect any organ or organ system of the body. We present a literature review and a rare clinical case from our clinical practice, in which a patient with metastatic clear cell renal carcinoma was treated with a single dose of dual checkpoint blockade (cytotoxic T-lymphocyte-4 (CTLA-4) and programmed death-1 (PD-1)) and simultaneously diagnosed with colitis, hepatitis, and nephritis. After early immunosuppressive treatment with the glucocorticoids, complete organ function recovery was achieved. The follow-up revealed a sustained complete response lasting more than a year.