Checkpoint inhibitor side effects

Thanks Missy for presenting a great case! This was a case of a patient who had received checkpoint inhibitor therapy for metastatic melanoma who presented with diffuse weakness found to have hypophysitis.

Main points:

  • 1) In approach to weakness first ask if the weakness is CNS, PNS/ neuromuscular, oxygen delivery or other. Also see my previous entry on this topic.
  • 2) Ipilimumab (anti-CTLA4) and nivolumab (anti-PD1) are part of a new class of cancer immunotherapy drugs classified as “checkpoint inhibitors,” and have been found to prolong life of a small subset of patients with certain cancers eg. metastatic melanoma
  • 3) A mnemonic to remember side effects of these drugs is LLEGS: Lung pneumonitis, Liver hepatitis, Endocrinopathies, GI (eg colitis), and Skin rashes (thanks to Jeremy Cetnar)

Want to learn more?

Framework for hyponatremia

In case you were looking for yet another approach to hyponatremia in addition to David Ellison’s excellent talk last week, here is a wonderful video by Palo Alto VA hospitalist Eric Strong that walks through the approach to hyponatremia.

Immunotherapy side effects

Here is a great review article from the Journal of Clinical Oncology on side effects of cancer immunotherapies. Below is table 1 which lists common side effects related to each drug class.