Hyponatremia and Fever in a Patient on Ipilimumab and Nivolumab (Immune Checkpoint Inhibitors): A Case Report.

Published on Sep 20, 2021in Journal of investigative medicine high impact case reports
· DOI :10.1177/23247096211045249
Sumit Patel2
Estimated H-index: 2
Sasmit Roy2
Estimated H-index: 2
(UVA: University of Virginia)
+ 3 AuthorsEesha S Patel
Immune checkpoint inhibitors (ICIs) are novel anticancer therapy approved in multiple tumors and their use is rapidly increasing. They are associated with various systemic side effects that are immune-mediated and clinically coined as "immune-related adverse effects" (irAE). Hyponatremia is a possible side effect in patients receiving ICIs. Fever is another side effect that is mostly non-infectious. There are different mechanisms leading to hyponatremia in patients on ICIs, which could be (1) hypovolemic hyponatremia due to hemodynamic disturbance secondary to volume depletion (eg, from irAE like colitis and enteritis) or hypervolemia due to congestive heart failure, cirrhosis, or nephrosis; (2) syndrome of inappropriate antidiuretic hormone (SIADH) secretion (especially from underlying lung cancer or neurological irAE like encephalitis and meningitis) with elevated urine sodium and urine osmolarity; and (3) irAE-related endocrinopathies such as hypophysitis, adrenal insufficiency, and hypothyroidism leading to euvolemic hyponatremia. We describe an interesting case of hyponatremia and fever in a patient receiving Ipilimumab and Nivolumab. The possible etiology of hyponatremia, in this case, was hypovolemia and volume depletion secondary to fever.
#1Karyne Pelletier (UHN: University Health Network)H-Index: 1
#2Marko Skrtic (UHN: University Health Network)H-Index: 17
Last. Abhijat Kitchlu (UHN: University Health Network)H-Index: 15
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Hyponatremia is the most common electrolyte disorder in patients with cancer and is associated with significant morbidity and mortality. Innovation in cancer therapies has led to substantial improv...
#1Russell W. Jenkins (Harvard University)H-Index: 30
#2David E. Fisher (Harvard University)H-Index: 108
Abstract The melanoma field has seen an unprecedented set of clinical advances over the past decade. Therapeutic efficacy for advanced or metastatic melanoma went from being one of the most poorly responsive to one of the more responsive. Perhaps most strikingly, the advances which transformed management of the disease are based upon modern mechanism-based therapeutic strategies. The targeted approaches which primarily suppress the BRAF oncoprotein pathway, have high predictability of efficacy a...
#1Harish Seethapathy (Harvard University)H-Index: 7
#2Nifasha Rusibamayila (Harvard University)H-Index: 2
Last. Meghan E. Sise (Harvard University)H-Index: 24
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BACKGROUND Hyponatremia due to endocrinopathies such as adrenal insufficiency and hypothyroidism has been reported in patients receiving immune checkpoint inhibitors (ICIs). We determined the risk and predictors of hyponatremia and other electrolyte abnormalities in a 'real-world' sample of patients receiving ICIs to treat advanced malignancies. METHODS This was a retrospective observational study of all patients who received ICIs from a single cancer center between 2011 and 2018. Patients were ...
Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) are inhibitory checkpoints that are commonly seen on activated T cells and have been offered as promising targets for the treatment of cancers. Immune checkpoint inhibitors (ICIs)targeting PD-1, including pembrolizumab and nivolumab, and those targeting its ligand PD-L1, including avelumab, atezolizumab, and durvalumab, and two drugs targeting CTLA-4, including ipilimumab and tremelimumab have been ap...
#1Xing He (CAS: Chinese Academy of Sciences)H-Index: 3
#2Chenqi Xu (CAS: Chinese Academy of Sciences)H-Index: 26
Immune checkpoint blockade therapy has become a major weapon in fighting cancer. Antibody drugs, such as anti-PD-1 and anti-PD-L1, demonstrate obvious advantages such as broad applicability across cancer types and durable clinical response when treatment is effective. However, the overall response rates are still unsatisfying, especially for cancers with low mutational burden. Moreover, adverse effects, such as autoimmune symptoms and tumor hyperprogression, present a significant downside in som...
#1Tim CooksleyH-Index: 15
#2A. GuptaH-Index: 15
Last. Paul LoriganH-Index: 73
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Abstract Introduction Immune-mediated toxicities are potentially fatal and can affect virtually any organ system. The prevalence of immune-mediated toxicity in patients being treated with immune checkpoint inhibitors (ICIs) is well described. However, the reasons for presentation and the prevalence of immune-mediated toxicity in acutely unwell patients being treated with ICIs is less well described. Materials and methods A prospective analysis of all emergency presentations in patients being tre...
#4Chris Thompson (RCSI: Royal College of Surgeons in Ireland)H-Index: 12
Abstract Adrenal insufficiency (AI) is a serious condition, which can arise from pathology affecting the adrenal gland itself (primary adrenal insufficiency, PAI), hypothalamic or pituitary pathology (secondary adrenal insufficiency, SAI), or as a result of suppression of the hypothalamic-pituitary-adrenal (HPA) axis by exogenous glucocorticoid therapy (tertiary adrenal insufficiency, TAI). AI is associated with an increase in morbidity and mortality and a reduction in quality of life. In additi...
#1Filipe Martins (EPFL: École Polytechnique Fédérale de Lausanne)H-Index: 6
#2Latifyan SofiyaH-Index: 1
Last. Michel Obeid (UPMC: Pierre-and-Marie-Curie University)H-Index: 17
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Immune-checkpoint inhibitors (ICIs), including anti-cytotoxic T lymphocyte antigen 4 (CTLA-4), anti-programmed cell death 1 (PD-1) and anti-programmed cell death 1 ligand 1 (PD-L1) antibodies, are arguably the most important development in cancer therapy over the past decade. The indications for these agents continue to expand across malignancies and disease settings, thus reshaping many of the previous standard-of-care approaches and bringing new hope to patients. One of the costs of these adva...
In the last decade, inhibitors targeting immune checkpoint molecules such as cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death 1 (PD-1) and programmed cell death-ligand 1 (PD-L1) brought about a major paradigm shift in cancer treatment. These immune checkpoint inhibitors (ICIs) improved the overall survival of a variety of cancer such as malignant melanoma and non-small lung cancer. In addition, numerous clinical trials for additional indication of ICIs including adjuvant and neo-...
#1Mario Sznol (Yale Cancer Center)H-Index: 83
Last. Jedd D. Wolchok (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 152
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PurposeThe addition of nivolumab (anti–programmed death-1 antibody) to ipilimumab (anti–cytotoxic T-cell lymphocyte–associated 4 antibody) in patients with advanced melanoma improves antitumor response and progression-free survival but with a higher frequency of adverse events (AEs). This cross-melanoma study describes the safety profile of the approved nivolumab plus ipilimumab regimen.MethodsThis retrospective safety review on data from three trials (phase I, II, and III) included patients wit...
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