Multiple Endocrine Toxicities in a Metastatic Cutaneous Melanoma Patient Treated with Checkpoint Inhibitors

Abstract

Metastatic cutaneous melanomas are typically treated with first-line checkpoint inhibitors, such as the anti-PD-1 antibody nivolumab and the anti-CTLA-4 antibody ipilimumab. Common immune-related adverse events (irAEs) from these therapies include dermatological, gastrointestinal, and endocrine toxicities. We present a case involving a 51-year-old woman with a prior medical history of Basedow's disease and multinodular goiter, who was diagnosed with metastatic cutaneous melanoma in 2019. Post-surgical intervention addressed most metastatic sites, leaving behind an inoperable axillary adenopathy. Initial treatment consisted of nivolumab (1 mg/kg) combined with ipilimumab (3 mg/kg). During this dual checkpoint inhibitor therapy, the patient developed hepatitis and primary hypothyroidism, prompting the discontinuation of ipilimumab. Monotherapy with nivolumab was subsequently administered. While on nivolumab, the patient developed additional irAEs, including type 1 diabetes mellitus and primary adrenal insufficiency. Despite these significant endocrinopathies, continuation of immunotherapy was permitted, ultimately resulting in a complete response.