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J Immunother Cancer . Severe acute myositis and myocarditis on initiation of 6-weekly pembrolizumab post-COVID-19 mRNA vaccination

tetano

Editor, Senior Moderator
J Immunother Cancer


. 2024 Apr 24;12(4):e008151.
doi: 10.1136/jitc-2023-008151. Severe acute myositis and myocarditis on initiation of 6-weekly pembrolizumab post-COVID-19 mRNA vaccination

Robert A Watson[SUP] 1 2 3 [/SUP], Weiyu Ye[SUP] 1 2 3 [/SUP], Chelsea A Taylor[SUP] 1 2 [/SUP], Elsita Jungkurth[SUP] 1 2 [/SUP], Rosalin Cooper[SUP] 1 2 [/SUP], Orion Tong[SUP] 1 2 [/SUP], Tim James[SUP] 4 [/SUP], Brian Shine[SUP] 4 [/SUP], Monika Hofer[SUP] 5 [/SUP], Damian Jenkins[SUP] 6 [/SUP], Robert Pell[SUP] 7 [/SUP], Eleni Ieremia[SUP] 7 [/SUP], Stephanie Jones[SUP] 8 [/SUP], David Maldonado-Perez[SUP] 8 [/SUP], Ian S D Roberts[SUP] 7 [/SUP], Nicholas Coupe[SUP] 3 [/SUP], Mark R Middleton[SUP] 2 3 [/SUP], Miranda J Payne[SUP] 3 [/SUP], Benjamin P Fairfax[SUP] 9 2 3 [/SUP]



Affiliations
Abstract

We describe three cases of critical acute myositis with myocarditis occurring within 22 days of each other at a single institution, all within 1 month of receiving the initial cycle of the anti-PD-1 drug pembrolizumab. Analysis of T cell receptor repertoires from peripheral blood and tissues revealed a high degree of clonal expansion and public clones between cases, with several T cell clones expanded within the skeletal muscle putatively recognizing viral epitopes. All patients had recently received a COVID-19 mRNA booster vaccine prior to treatment and were positive for SARS-CoV2 Spike antibody. In conclusion, we report a series of unusually severe myositis and myocarditis following PD-1 blockade and the COVID-19 mRNA vaccination.

Keywords: Case Reports; Immune Checkpoint Inhibitors; Melanoma; Receptors, Antigen; T-Lymphocytes.

 
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