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

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.
PMID: 32400023 [PubMed - as supplied by publisher]

Source: The Oncologist - May 12, 2020 Category: Cancer & Oncology Authors: 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 QZ, Wakeland EK, Gerber DE Tags: Oncologist Source Type: research