Successful use of equine anti-thymocyte globulin (ATGAM) for fulminant myocarditis secondary to nivolumab therapy.

Br J Cancer 2017 Sep 10;117(7):921-924. Epub 2017 Aug 10.

Department of Medical Oncology, Alfred Health, Melbourne, Victoria 3004, Australia.

Background: Immune-mediated myocarditis is an uncommon adverse effect of immune checkpoint inhibition and is associated with a high rate of mortality.

Methods: In this reported case, a 64-year-old woman with right temporo-parietal glioblastoma IDH-WT was treated with nivolumab, temozolomide and radiation therapy on a clinical trial. She developed malignant arrhythmias secondary to histologically confirmed severe immune-mediated myocarditis. She was treated with equine anti-thymocyte globulin (ATGAM) due to development of malignant arrhythmias refractory to high-dose corticosteroids.

Results: This report describes the only case of immune-mediated myocarditis treated with ATGAM resulting in a favourable outcome.

Conclusions: Use of ATGAM should be considered in cases of steroid-refractory immune-mediated myocarditis and administered in close consultation with a cardiac transplant team experienced in the use of this agent.

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http://dx.doi.org/10.1038/bjc.2017.253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625667PMC
September 2017
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