Secondary complications of drug-related immune-mediated adverse events in clinical trials, patient case study

Immune checkpoint inhibitors have become the first-line treatment for melanoma and many metastatic solid tumours as they are efficacious and generally well-tolerated. Nivolumab is a fully human, monoclonal igG4 antibody that binds to the programmed death-1 (PD-1) receptor to relieve immune suppression factors. The PD-1 inhibitor enhances T-cell activity by allowing T-cell receptors to recognise antigens on the cell surface facilitating tumour cell destruction by the host immune system. However, abnormal activation of autoreactive T-cells can lead to inflammation in any organ system. The lungs are one of the most commonly affected organs with pneumonitis a serious pulmonary toxicity associated with high morbidity rates. Neurologic immune- related adverse events rarely occur and are challenging to identify due to their subtle presentation and varying symptoms. Although checkpoint inhibitors aim to elicit an amplified immune response, it can go awry leading to permanent side effects as those seen in Darren’s case.