TY - JOUR
T1 - Statin Intolerance, Anti-HMGCR Antibodies, and Immune Checkpoint Inhibitor-Associated Myositis
T2 - A “Two-Hit” Autoimmune Toxicity or Clinical Predisposition?
AU - von Itzstein, Mitchell S.
AU - Khan, Shaheen
AU - Popat, Vinita
AU - Lu, Rong
AU - Khan, Saad A.
AU - Fattah, Farjana J.
AU - Park, Jason Y.
AU - Bermas, Bonnie L.
AU - Karp, David R.
AU - Ahmed, Murtaza
AU - Saltarski, Jessica M.
AU - Gloria-McCutchen, Yvonne
AU - Xie, Yang
AU - Li, Quan Zhen
AU - Wakeland, Edward K.
AU - Gerber, David E.
N1 - Publisher Copyright:
© AlphaMed Press 2020
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Immune-related adverse events induced by immune checkpoint inhibitor (ICI) therapy may affect diverse organ systems, including skeletal and cardiac muscle. ICI-associated myositis may result in substantial morbidity and occasional mortality. We present a case of a patient with advanced non-small cell lung cancer who developed grade 4 myositis with concurrent myocarditis early after initiation of anti-programmed death ligand 1 therapy (durvalumab). Autoantibody analysis revealed marked increases in anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibody levels that preceded clinical toxicity, and further increased during toxicity. Notably, the patient had a history of intolerable statin myopathy, which had resolved clinically after statin discontinuation and prior to ICI initiation. This case demonstrates a potential association between statin exposure, autoantibodies, and ICI-associated myositis.
AB - Immune-related adverse events induced by immune checkpoint inhibitor (ICI) therapy may affect diverse organ systems, including skeletal and cardiac muscle. ICI-associated myositis may result in substantial morbidity and occasional mortality. We present a case of a patient with advanced non-small cell lung cancer who developed grade 4 myositis with concurrent myocarditis early after initiation of anti-programmed death ligand 1 therapy (durvalumab). Autoantibody analysis revealed marked increases in anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibody levels that preceded clinical toxicity, and further increased during toxicity. Notably, the patient had a history of intolerable statin myopathy, which had resolved clinically after statin discontinuation and prior to ICI initiation. This case demonstrates a potential association between statin exposure, autoantibodies, and ICI-associated myositis.
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U2 - 10.1634/theoncologist.2019-0911
DO - 10.1634/theoncologist.2019-0911
M3 - Article
C2 - 32400023
AN - SCOPUS:85085895830
SN - 1083-7159
VL - 25
SP - e1242-e1245
JO - Oncologist
JF - Oncologist
IS - 8
ER -