Rhabdomyolysis during high dose interleukin-2 treatment of metastatic melanoma after sequential immunotherapies: a case report

Abstract

BackgroundThe treatment options for metastatic malignant melanoma have drastically changed recently,including the increased use of immunotherapeutic agents that offer significant responses. Accordingly, it hasbecome common for sequential administration of such agents. Despite this, no guidelines exist on propersequencing or potential unique toxicities associated with such sequencing.Case presentationWe describe here the first incidence, to our knowledge, of clinically significant rhabdomyolysis associated with high-dose interleukin-2 after prior treatment with ipilimumab, genetically engineered T-cell therapy and subsequent single agent pembrolizumab in a patient with BRAF wild type metastatic malignant melanoma.ConclusionFurther studies into the biology of sequential immunotherapy in the treatment of cancer are warranted.

Pembrolizumab-induced hypothyroidism manifesting as myopathy and psychosis

“…Whether pembrolizumab itself contributed to the development of psychosis remains speculative but because psychosis has not been reported in the absence of hypothyroidism, it was most likely secondary due to hypothyroidism. Because pembrolizumab can cause rhabdomyolysis [3][4][5], it remains unclear if hypothyroidism alone, pembrolizumab alone, or both were responsible for hyper-CKemia.…”

“…Hypothyroidism as a side effect of the immune-checkpoint inhibitor pembrolizumab is well appreciated [1,2]. Pembrolizumab has been also reported to induce rhabdomyolysis in some cases [3][4][5] or myositis [6]. Pembrolizumab-induced hypothyroidism manifesting as psychosis together with creatine-kinase (CK) elevation, however, has not been reported.…”