title: Immunosuppression for ipilimumab-related toxicity can causepneumocystispneumonia but spare antitumor immune control.
abstract: Ipilimumab is a standard therapy for advanced melanoma. Severe immune related adverse events occur in up to 30% of patients and require treatment with immunosuppressants such as steroids or the anti-TNFα antibody, infliximab. We describe two patients with advanced melanoma treated with ipilimumab. Both suffered from severe immune related side effects and required prolonged immunosuppression with steroids and/or infliximab. Both patients recovered and in spite of the immune suppression, demonstrate clinical evidence of tumor control. This argues that distinct immunological effector functions control nosocomial infection and tumor, respectively. To our knowledge, these are also the first two case reports of pneumocystis pneumonia in this setting.
authors.affiliation: Cancer Sciences Unit; University of Southampton and University Hospital Southampton NHS Foundation Trust ; Southampton, UK ; University Hospital Southampton NHS Foundation Trust ; Southampton, UK ; Southampton Experimental Cancer Medicine Center; University of Southampton and University Hospital Southampton NHS Foundation Trust ; Southampton, UK.
authors.forename: Edurne
authors.initials: E
authors.lastname: Arriola
authors.affiliation: University Hospital Southampton NHS Foundation Trust ; Southampton, UK ; Southampton Experimental Cancer Medicine Center; University of Southampton and University Hospital Southampton NHS Foundation Trust ; Southampton, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wheater
authors.affiliation: University Hospital Southampton NHS Foundation Trust ; Southampton, UK.
authors.forename: Radhika
authors.initials: R
authors.lastname: Krishnan
authors.affiliation: University Hospital Southampton NHS Foundation Trust ; Southampton, UK.
authors.forename: James
authors.initials: J
authors.lastname: Smart
authors.affiliation: University Hospital Southampton NHS Foundation Trust ; Southampton, UK.
authors.forename: Vipul
authors.initials: V
authors.lastname: Foria
authors.affiliation: Cancer Sciences Unit; University of Southampton and University Hospital Southampton NHS Foundation Trust ; Southampton, UK ; University Hospital Southampton NHS Foundation Trust ; Southampton, UK ; Southampton Experimental Cancer Medicine Center; University of Southampton and University Hospital Southampton NHS Foundation Trust ; Southampton, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: Ottensmeier
keywords: immunosuppression; infliximab; ipilimumab; melanoma; opportunistic; pneumocystis; pneumonia; steroids