Successful use of equine anti-thymocyte globulin (ATGAM) for fulminant myocarditis secondary to nivolumab therapy

• Published in: British journal of cancer Vol. 117; no. 7; pp. 921 - 924
• Main Authors: Tay, Rebecca Y, Blackley, Elizabeth, McLean, Catriona, Moore, Maggie, Bergin, Peter, Gill, Sanjeev, Haydon, Andrew
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 26.09.2017; Nature Publishing Group
• Subjects: 631/250/251; 631/67/1059/2325; Animals; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - adverse effects; Antilymphocyte Serum - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomedical and Life Sciences; Biomedicine; Brain Neoplasms - therapy; Cancer Research; Cardiac arrhythmia; Chemoradiotherapy; Clinical Study; Consultation; Corticoids; Corticosteroids; Dacarbazine - administration & dosage; Dacarbazine - analogs & derivatives; Drug Resistance; Epidemiology; Female; Glioblastoma; Glioblastoma - therapy; Globulins; Heart diseases; Heart transplantation; Horses; Humans; Immune checkpoint inhibitors; Immunotherapy; Middle Aged; Molecular Medicine; Monoclonal antibodies; Myocarditis; Myocarditis - chemically induced; Myocarditis - immunology; Myocarditis - therapy; Oncology; Radiation; Radiation therapy; Targeted cancer therapy; Temozolomide; Thymocytes; glioblastoma; nivolumab; immune related adverse events; anti-thymocyte globulin; myocarditis; immunotherapy; ATGAM; checkpoint inhibitor
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2017.253

Background: Immune-mediated myocarditis is an uncommon adverse effect of immune checkpoint inhibition and is associated with a high rate of mortality. Methods: In this reported case, a 64-year-old woman with right temporo-parietal glioblastoma IDH-WT was treated with nivolumab, temozolomide and radiation therapy on a clinical trial. She developed malignant arrhythmias secondary to histologically confirmed severe immune-mediated myocarditis. She was treated with equine anti-thymocyte globulin (ATGAM) due to development of malignant arrhythmias refractory to high-dose corticosteroids. Results: This report describes the only case of immune-mediated myocarditis treated with ATGAM resulting in a favourable outcome. Conclusions: Use of ATGAM should be considered in cases of steroid-refractory immune-mediated myocarditis and administered in close consultation with a cardiac transplant team experienced in the use of this agent.