Immune-mediated Myocarditis after Durvalumab/tremelimumab Treatment for Unresectable Hepatocellular Carcinoma
Abstract
Immune checkpoint inhibitors (ICIs) are important for the treatment of unresectable hepatocellular carcinoma (HCC). Furthermore, severe immune-mediated adverse events (imAEs) can be life threatening. We herein report a case of myocarditis and myositis after ICI treatment. A male patient with unresectable HCC was treated with durvalumab and tremelimumab. Three weeks later, the patient presented to the emergency department with syncope. Electrocardiography revealed a complete atrioventricular block. Therefore, immune-mediated myocarditis was suspected. High-dose corticosteroid therapy was initiated immediately and temporary pacing was required. The patient's cardiac conduction gradually improved and his spontaneous rhythm was restored. This case highlights the importance of the early recognition and prompt management of imAEs, particularly myocarditis. Clinicians should be vigilant as delayed intervention may be fatal.
Related
- A Case of Unresectable Hepatocellular Carcinoma Responding to Durvalumab Plus Tremelimumab after Lenvatinib Treatment
- Outcomes by Comorbidities with Tremelimumab and Durvalumab in the Randomized, Controlled Phase 3 HIMALAYA Study in Unresectable Hepatocellular Carcinoma.
- Outcomes in the Asian subgroup of the phase III randomised HIMALAYA study of tremelimumab plus durvalumab in unresectable hepatocellular carcinoma
- An Effective Case of Radiofrequency Ablation with the Combination of Durvalumab and Tremelimumab Treatment for Hepatocellular Carcinoma
- An integrated Phase II/III randomized study comparing durvalumab and tremelimumab ± Hepatic ArteriaL infusion chemotherapy with GEMOX in hepatocellular Carcinoma with high tumor burdEn – ALICE (PRODIGE89 – UCGI44 – ALICE)
BibTeX
@article{mawatari2026immunemediated,
title = {{Immune-mediated Myocarditis after Durvalumab/tremelimumab Treatment for Unresectable Hepatocellular Carcinoma}},
author = {Shogo Mawatari and Ryu Sasaki and Yasuhiko Nakao and Masanori Fukushima and Masafumi Haraguchi and Satoshi Miuma and Hisamitsu Miyaaki},
journal = {Internal Medicine},
year = {2026},
month = oct,
doi = {10.2169/internalmedicine.6647-25},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/65/19/65_6647-25/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Immune-mediated Myocarditis after Durvalumab/tremelimumab Treatment for Unresectable Hepatocellular Carcinoma
AU - Shogo Mawatari
AU - Ryu Sasaki
AU - Yasuhiko Nakao
AU - Masanori Fukushima
AU - Masafumi Haraguchi
AU - Satoshi Miuma
AU - Hisamitsu Miyaaki
PY - 2026
DA - 2026/10/01
JO - Internal Medicine
DO - 10.2169/internalmedicine.6647-25
UR - https://www.jstage.jst.go.jp/article/internalmedicine/65/19/65_6647-25/_article
AB - Immune checkpoint inhibitors (ICIs) are important for the treatment of unresectable hepatocellular carcinoma (HCC). Furthermore, severe immune-mediated adverse events (imAEs) can be life threatening. We herein report a case of myocarditis and myositis after ICI treatment. A male patient with unresectable HCC was treated with durvalumab and tremelimumab. Three weeks later, the patient presented to the emergency department with syncope. Electrocardiography revealed a complete atrioventricular block. Therefore, immune-mediated myocarditis was suspected. High-dose corticosteroid therapy was initiated immediately and temporary pacing was required. The patient's cardiac conduction gradually improved and his spontaneous rhythm was restored. This case highlights the importance of the early recognition and prompt management of imAEs, particularly myocarditis. Clinicians should be vigilant as delayed intervention may be fatal.
SN - 1349-7235
SN - 0918-2918
ER -