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25 January 2019 : Case report  Japan

A Case of Acute Exacerbation of Chronic Adrenal Insufficiency Due to Ipilimumab Treatment for Advanced Melanoma

Unusual clinical course, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction

Chihiro Sakaguchi1ABCDEF, Seiichi Yano1CDE, Kenji Ashida21ABCDEF*, Naoko Wada3BCDE, Kenji Ohe4ACDE, Hiromi Nagata1DE, Yayoi Matsuda1DE, Shohei Sakamoto1DE, Ryuichi Sakamoto1DE, Keizo Ohnaka5DE, Hiroshi Uchi3DE, Masutaka Furue3DE, Masatoshi Nomura21ACDE, Yoshihiro Ogawa1DE

DOI: 10.12659/AJCR.913021

Am J Case Rep 2019; 20:106-110

Abstract

BACKGROUND: Ipilimumab is a therapeutic human monoclonal antibody that targets the T-cell inhibitory molecule, cytotoxic T-lymphocyte antigen-4 (CTLA-4), and is classified as an immune checkpoint inhibitor that has been shown to improve prognosis in patients with advanced melanoma. However, several immune-related adverse events have been reported to be associated with ipilimumab Treatment. A case of acute exacerbation of chronic adrenal insufficiency is presented that highlights that glucocorticoid dosage for patients undergoing steroid treatment at the time of ipilimumab treatment has yet to be established.

CASE REPORT: A 50-year-old Japanese woman was diagnosed with malignant melanoma on the sole of her right foot. During her second course of ipilimumab treatment, she developed acute adrenal insufficiency caused by isolated adrenocorticotropic hormone (ACTH) deficiency, which required treatment with oral hydrocortisone. However, the symptoms of her adrenal insufficiency worsened, and she commenced treatment with 12 courses of nivolumab, a therapeutic human monoclonal antibody that blocks programmed cell death protein 1 (PD-1) on the surface of T-cells. She did not require corticosteroid support during nivolumab treatment.

CONCLUSIONS: This case report highlights the risk of exacerbating adrenal insufficiency during treatment with ipilimumab. The differences in clinical outcome in this patient between ipilimumab and nivolumab treatment might be explained by the different mechanisms between ipilimumab and nivolumab on immune function.

Keywords: adrenal insufficiency, CTLA-4 Antigen, Glucocorticoids, Melanoma, Programmed Cell Death 1 Receptor, Antineoplastic Agents, Immunological, Ipilimumab, Skin Neoplasms

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923