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

Al's Comment:

 This is a very rare, but very serious,  side effect of checkpoint inhibitors. Although it is only 1 patient, keep this in mind if you hear of this side effect.


Posted on: 08/14/2017

2. Br J Cancer. 2017 Aug 10. doi: 10.1038/bjc.2017.253. [Epub ahead of print]
Successful use of equine anti-thymocyte globulin (ATGAM) for fulminant myocarditis secondary to nivolumab therapy.
Tay RY1, Blackley E1, McLean C2,3, Moore M1, Bergin P4, Gill S1, Haydon A1,3.
 
Author information:
 
1
    Department of Medical Oncology, Alfred Health, Melbourne, Victoria 3004, Australia.
2
    Department of Anatomical Pathology, Alfred Health, Melbourne, Victoria 3004, Australia.
3
    Monash University, Melbourne, Victoria 3800, Australia.
4
    Heart Centre, Alfred Health, Melbourne, Victoria 3004, Australia.
 
Abstract
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.British Journal of Cancer advance online publication: 10 August 2017; doi:10.1038/bjc.2017.253 www.bjcancer.com.
PMID: 28797029 

 


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