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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalOncologist
DOIs
StateAccepted/In press - 2020

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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