Title |
Progressive hypoventilation due to mixed CD8+ and CD4+ lymphocytic polymyositis following tremelimumab - durvalumab treatment
|
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Published in |
Journal for Immunotherapy of Cancer, July 2017
|
DOI | 10.1186/s40425-017-0258-x |
Pubmed ID | |
Authors |
Sooraj John, Scott J. Antonia, Trevor A. Rose, Robert P. Seifert, Barbara A. Centeno, Aaron S. Wagner, Ben C. Creelan |
Abstract |
The combination of CTLA-4 and PD-L1 inhibitors has a manageable adverse effect profile, although rare immune-related adverse events (irAE) can occur. We describe an autoimmune polymyositis following a partial response to combination tremelimumab and durvalumab for the treatment of recurrent lung adenocarcinoma. Radiography revealed significant reduction in all metastases; however, the patient developed progressive neuromuscular hypoventilation due to lymphocytic destruction of the diaphragmatic musculature. Serologic testing revealed a low level of de novo circulating antibodies against striated muscle fiber. Immunohistochemistry revealed type II muscle fiber atrophy with a mixed CD8(+) and CD4(+) lymphocyte infiltrate, indicative of inflammatory myopathy. This case supports the hypothesis that muscle tissue is a target for lymphocytic infiltration in immune checkpoint inhibitor-associated polymyositis. Further insights into the autoimmune mechanism of PM will hopefully contribute to the prevention and treatment of this phenomenon. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 2 | 50% |
Belgium | 1 | 25% |
Unknown | 1 | 25% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 2 | 50% |
Practitioners (doctors, other healthcare professionals) | 1 | 25% |
Science communicators (journalists, bloggers, editors) | 1 | 25% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 57 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 7 | 12% |
Student > Doctoral Student | 7 | 12% |
Student > Ph. D. Student | 6 | 11% |
Student > Master | 6 | 11% |
Researcher | 4 | 7% |
Other | 12 | 21% |
Unknown | 15 | 26% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 24 | 42% |
Pharmacology, Toxicology and Pharmaceutical Science | 3 | 5% |
Neuroscience | 3 | 5% |
Immunology and Microbiology | 3 | 5% |
Computer Science | 1 | 2% |
Other | 2 | 4% |
Unknown | 21 | 37% |