Australian researchers are warning of some rare but deadly side effects of Opdivo (nivolumab) for pleural mesothelioma.
They have just published a case report of a mesothelioma patient on nivolumab, a drug often used to treat lung cancer. The patient developed swelling of the heart and other muscles. The swelling lasted for months, even after they stopped taking the drug.
The case report details the healthcare teams’ effort to manage these potentially lethal side effects of Opdivo. They caution that other immune checkpoint inhibitors might cause similar complications.
How Opdivo Fights Mesothelioma
The primary treatment for mesothelioma is chemotherapy with pemetrexed (Alimta). Eventually, most patients stop responding to chemotherapy. At that point, doctors may turn to an immunotherapy drug like Opdivo.
Mesothelioma cells produce a protein called PD-L1 to avoid detection by the immune system. Opdivo (nivolumab) blocks that protein. This makes mesothelioma cells more susceptible to treatment.
A recent Japanese study found the side effects of Opdivo to be “manageable” for most patients. But some side effects are more serious than others. The Australian study suggests that not every mesothelioma patient can tolerate this drug.
Serious Side Effects of Opdivo in Australian Patient
The Australian case study focuses on a mesothelioma patient who took Opdivo after chemotherapy stopped working. The patient had two cycles of treatment with Opdivo.
After the second cycle, two serious side effects of Opdivo emerged. The first was myositis, an inflammation of the muscles that can cause weakness, swelling, and pain. The second side effect was myocarditis. This is a swelling of the heart muscle which can be fatal.
When it is injured, the heart releases a protein called troponin. Doctors gave the patient immunosuppressive drugs and corticosteroids to try to calm the side effects of Opdivo. But the patient’s troponin levels stayed high for months.
And what about the mesothelioma tumor? The researchers say the patient had “an impressive but brief” response to the treatment. But they warn doctors to watch for the dangerous side effects of Opdivo.
“Myocarditis and myositis are rare complications of immune checkpoint inhibitors,” they write in Translational Lung Cancer Research. “Clinicians should be aware of these possible complications as myocarditis can result in mortality.”
Keytruda (pembrolizumab) is another immune checkpoint inhibitor that works similarly to Opdivo. The Australian research suggests that it could also cause these serious side effects in some people.
Lie, Gabrielle, at el, “Nivolumab Resulting in Persistently Elevated Troponin Levels Despite Clinical Remission of Myocarditis and Myositis in a Patient With Malignant Pleural Mesothelioma: Case Report”, April 9, 2020, Translational Lung Cancer Research, http://tlcr.amegroups.com/article/view/38433/html