What happened, in summary

A 74-year-old woman was diagnosed with Stage IV lung adenocarcinoma involving both lungs. Molecular testing was negative for EGFR, ALK, and ROS1, and PD-L1 expression was below 1%. She began first-line nivolumab plus ipilimumab and received 3 cycles. Two weeks after the third cycle, she developed marked fatigue, palpitations, low blood pressure, rapid heart rate, and abnormal cardiac testing. A multidisciplinary team diagnosed acute perimyocarditis caused by immunotherapy. Nivolumab and ipilimumab were stopped, and she was treated with high-dose prednisone, colchicine, and supportive care. Her cardiac symptoms and testing improved substantially over the following 2 weeks. She then continued cancer treatment with carboplatin and pemetrexed. Despite recovery from the immune-related cardiac complication, the lung cancer progressed, and she died 3 months later.