Case Report: A Variety of Immune-Related Adverse Events Triggered by Immune Checkpoint Inhibitors in a Subject With Malignant Melanoma: Destructive Thyroiditis, Aseptic Meningitis and Isolated ACTH Deficiency

• Published in: Frontiers in endocrinology (Lausanne) Vol. 12; p. 722586
• Main Authors: Katakura, Yukino, Kimura, Tomohiko, Kusano, Takashi, Tatsumi, Fuminori, Iwamoto, Yuichiro, Sanada, Junpei, Fushimi, Yoshiro, Shimoda, Masashi, Kohara, Kenji, Nakanishi, Shuhei, Kaku, Kohei, Mune, Tomoatsu, Kaneto, Hideaki
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 12.10.2021
• Subjects: Adrenocorticotropic Hormone - deficiency; Antineoplastic Agents, Immunological - administration & dosage; Antineoplastic Agents, Immunological - adverse effects; Antineoplastic Combined Chemotherapy Protocols; aseptic meningitis; Atrophy - chemically induced; destructive thyroiditis; Endocrine System Diseases - chemically induced; Endocrine System Diseases - diagnosis; Endocrinology; Genetic Diseases, Inborn - chemically induced; Genetic Diseases, Inborn - diagnosis; Humans; Hypoglycemia - chemically induced; Hypoglycemia - diagnosis; immune checkpoint inhibitor; Immune Checkpoint Inhibitors - administration & dosage; Immune Checkpoint Inhibitors - adverse effects; immune-related adverse event; Ipilimumab - administration & dosage; Ipilimumab - adverse effects; isolated ACTH deficiency; Japan; Male; Melanoma - drug therapy; Melanoma, Cutaneous Malignant; Meningitis, Aseptic - chemically induced; Meningitis, Aseptic - diagnosis; Middle Aged; Nivolumab - administration & dosage; Nivolumab - adverse effects; Skin Neoplasms - drug therapy; Thyroid Gland - drug effects; Thyroid Gland - pathology; Thyroiditis - chemically induced; Thyroiditis - diagnosis; Thyroiditis - pathology; Japan; isolated ACTH deficiency; immune checkpoint inhibitor; aseptic meningitis; destructive thyroiditis; immune-related adverse event
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2021.722586

Recently, immune checkpoint inhibitors have been drawing much attention as cancer immunotherapy, but it has been shown that various immune-related adverse events (irAEs) are induced by immune checkpoint inhibitors in various organs, which has become one of the serious issues at present. A 58-year-old Japanese male with malignant melanoma was treated with nivolumab and/or ipilimumab. During the period of treatment, he suffered from various irAEs. Firstly, about 1 month after starting nivolumab monotherapy, destructive thyroiditis was induced, and so we started replacement therapy with levothyroxine. Secondly, about 1 month after starting nivolumab and ipilimumab combination therapy, aseptic meningitis was induced. We stopped both drugs and started steroid therapy with prednisolone. Finally, about 9 months after restarting nivolumab, isolated adrenocorticotropic hormone (ACTH) deficiency was induced, and so we started replacement therapy with hydrocortisone. Taken together, we should bear in mind the possibility of a variety of irAEs when we use immune checkpoint inhibitors.