title: Left Ventricular Dysfunction After Treatment With Ipilimumab for Metastatic Melanoma.
abstract: Ipilimumab is a monoclonal antibody targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) that is approved by the US Food and Drug Administration for the treatment of unresectable or metastatic melanoma. Ipilimumab is known to cause immune-mediated adverse reactions because of the resultant increase in T-cell activity. To date, there are no published reports of ipilimumab-related heart failure, although a recently published report describes a case of transient cardiomyopathy associated with its use. We report the case of a 60-year-old man who developed left ventricular dysfunction with an asymptomatic reduction in ejection fraction from 55%-60% at baseline to 40%-45% 4 months after completing a second course of treatment with ipilimumab for metastatic melanoma. Ipilimumab was not restarted, and the patient was initiated on lisinopril and carvedilol. Repeat echocardiograms 3 and 5 months later revealed ejection fractions of 40%-45% and 55%-60%, respectively.
authors.affiliation: 1Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC; 2Division of Cardiology, University of North Carolina Medical Center, Chapel Hill, NC; 3UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; 4UNC McAllister Heart Institute, Chapel Hill, NC; 5Center for Heart and Vascular Care, University of North Carolina Medical Center, Chapel Hill, NC; 6Department of Medicine, University of North Carolina Medical Center, Chapel Hill, NC; and 7Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Roth
authors.forename: Benyam
authors.initials: B
authors.lastname: Muluneh
authors.forename: Brian C
authors.initials: BC
authors.lastname: Jensen
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Madamanchi
authors.forename: Carrie B
authors.initials: CB
authors.lastname: Lee
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000139:chemically induced*; D002037:Bundle-Branch Block / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D000074324:Ipilimumab; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary; D008875:Middle Aged; D012878:Skin Neoplasms / Q000473:pathology*; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced*
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab