Abstract
BackgroundAlthough rare, several immune-related adverse effects can be life-threatening. Here, we describe a metastatic gastric cancer patient presenting with nivolumab-related myasthenia gravis and myocarditis, a previously unreported adverse effect of gastric cancer treatment.Case presentationA 66-year-old man with metastatic gastric cancer visited the emergency department because of dizziness after the first dose of nivolumab. Diagnoses of nivolumab-related myasthenia gravis and myocarditis were established. Myocardial biopsy results and anti-acetylcholine receptor antibody positivity confirmed the diagnoses. Despite plasma exchange and intravenous methylprednisolone and immunoglobulin administration, the patient’s general condition gradually worsened, and he died.ConclusionsStrict monitoring for cardiac and neuromuscular symptoms after nivolumab administration is necessary to rapidly treat these adverse effects.
Highlights
Rare, several immune-related adverse effects can be life-threatening
Adverse effects of nivolumab in metastatic gastric cancer patients were summarized in phase 3, ATTRACTION-2 clinical trial [2]
The incidence rates of myasthenia gravis (MG) and myocarditis as immunerelated adverse effects (irAEs) are less than 1%, with a mortality rate of 37.5% (3 out of 8) when they occur simultaneously (Table 1) [1, 3]
Summary
Several immune-related adverse effects can be life-threatening. Here, we describe a metastatic gastric cancer patient presenting with nivolumab-related myasthenia gravis and myocarditis, a previously unreported adverse effect of gastric cancer treatment.Case presentation: A 66-year-old man with metastatic gastric cancer visited the emergency department because of dizziness after the first dose of nivolumab. Background Immune checkpoint inhibitors (ICIs) such as nivolumab, known as anti-programmed cell death protein 1 (PD1) inhibitors, are widely used to treat metastatic cancer patients. We present a case of nivolumab-related MG and myocarditis occurring in a metastatic gastric cancer patient. The above treatment was performed, the patient appeared to have a progressive disease, and nivolumab alone was selected as the third-line chemotherapy.
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