Statin Intolerance, anti-HMGCR Antibodies, and Immune Checkpoint Inhibitor-Associated Myositis: A "Two-Hit" Autoimmune Toxicity or Clinical Predisposition?

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von Itzstein, Mitchell S
Khan, Shaheen
Popat, Vinita
Lu, Rong
Khan, Saad A
Fattah, Farjana J
Park, Jason Y
Bermas, Bonnie L
Karp, David R
Ahmed, Murtaza
Saltarski, Jessica M
Gloria-McCutchen, Yvonne
Xie, Yang
Li, Quan-Zhen
Wakeland, Edward K
Gerber, David E
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2020
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Abstract

Immune-related adverse events induced by immune checkpoint inhibitor (ICI) therapy may affect diverse organ systems, including skeletal and cardiac muscle. ICI-associated myositis may result in substantial morbidity and occasional mortality. We present a case of a patient with advanced non-small cell lung cancer who developed grade 4 myositis with concurrent myocarditis early after initiation of anti-programmed death ligand 1 therapy (durvalumab). Autoantibody analysis revealed marked increases in anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibody levels that preceded clinical toxicity, and further increased during toxicity. Notably, the patient had a history of intolerable statin myopathy, which had resolved clinically after statin discontinuation and prior to ICI initiation. This case demonstrates a potential association between statin exposure, autoantibodies, and ICI-associated myositis.

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Oncologist

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This publication has been entered in Griffith Research Online as an advanced online version.

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Oncology and carcinogenesis

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von Itzstein, MS; Khan, S; Popat, V; Lu, R; Khan, SA; Fattah, FJ; Park, JY; Bermas, BL; Karp, DR; Ahmed, M; Saltarski, JM; Gloria-McCutchen, Y; Xie, Y; Li, Q-Z; Wakeland, EK; Gerber, DE, Statin Intolerance, anti-HMGCR Antibodies, and Immune Checkpoint Inhibitor-Associated Myositis: A "Two-Hit" Autoimmune Toxicity or Clinical Predisposition?, Oncologist, 2020

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