A burning heart: combined therapy of checkpoint-inhibitors and prednisolone in a patient with sarcoidosis

Abstract

Patients with prior autoimmune diseases such as sarcoidosis require special care when treated with checkpoint inhibitors (CPIs), given the risk for reactivation of inflammation. Here, we address the clinical dilemma of initiating CPIs for recurrent metastatic carcinoma in a patient with extensive sarcoidosis, controlled after prolonged immunosuppressive therapy when the tumor recurrence was detected. To achieve the best possible outcome, the case was discussed by an interdisciplinary team comprising specialists in rheumatology, oncology, and CPI-related myocarditis. Literature on this topic was very limited. Based on the pharmacodynamics of CPIs and the pathophysiology of CPI-related autoimmune diseases, we concluded that initiating CPIs alongside low-dose prednisolone would effectively suppress any reactivation of sarcoidosis without interfering with CPIs in a relevant way.

Keywords

CPI / sarcoidosis / myocarditis / autoimmune disease / sudden cardiac arrest / prednisolone

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