engleski

Adrenal Insufficiency and Cardiac Failure During Nivolumab Treatment: A Case Report

Abstract: Introduction: Oncologists in Croatia are practicing immunotherapy within health insurance coverage and guidelines since February 2017, when pembrolizumab became available for melanoma patients. In 2018, nivolumab was available in the same indication. The healthcare professionals' experience with immunotherapy-related toxicities is limited and the clinicians are facing situations with completely different types of oncology treatment toxicities, their identification and treatment. Case report: We present the case of metastatic melanoma patient treated with nivolumab who have had two serious adverse events during treatment: adrenal insufficinecy and cardiac failure. Data on nivolumab-related toxicities report incidence of 1% for adrenal insufficiency and less than 1% for myocarditis, but both in one patient we did not find in literature review. A relatively young male patient with many previous medical conditions but none of known autoimmune origin, was treated with nivolumab for metastatic BRAF- negative melanoma in the first-line. After doubling the dose and interval scheme after 3 months of two-weeks-regime, an onset of grade 3 adrenal insufficiency occured. After re- initianting the medication in lower dose, he had another severe toxicity after 2 months of treatment – probable myocarditis and grade 3 cardiac failure. Unfortunately, cardiologists did not suspect autoimmune event and did not perform myocardial biopsy so the etiology of the condition remained unconfirmed. Since PET- CT after 6 nivolumab cycles showed complete disease remission, we decided not to continue the treatment. Conclusion: Autoimmune toxicities represent a brand new spectrum of oncology patients' adverse events which other clinicians are still not acquainted with and not prepared for promptly reaction with suitable diagnostic and therapeutical approaches.

adrenal insufficiency ; cardiac failure ; nivolumab

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