What happened, in summary

A 49-year-old woman underwent surgery for right upper-lobe lung adenocarcinoma. Pathology classified the cancer as Stage II, and PD-L1 expression was 50%. She then received adjuvant chemotherapy. Cisplatin plus vinorelbine was stopped after one course because of severe neutropenia, and she completed 2 additional courses with carboplatin plus paclitaxel. Atezolizumab was then started as postoperative systemic therapy. Within weeks she developed persistent fever, worsening shortness of breath and shock. Cardiac testing confirmed fulminant myocarditis linked to the immune treatment, requiring intensive care and immunosuppressive treatment. Atezolizumab was discontinued. More than 1 year later, there had been no recurrence of her lung cancer. Her case illustrates a serious immune-related complication during otherwise adjuvant treatment for non-metastatic disease.