Dual-organ toxicity during treatment with nivolumab and ipilimumab in combination with chemotherapy in the first-line treatment of non-small cell lung cancer

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of non-small cell lung cancer (NSCLC). The combination of nivolumab and ipilimumab with two cycles of chemotherapy improves treatment efficacy; however, this combination therapy is also associated with a high incidence of adverse events. We report a rare and significant case of dual-organ failure following treatment with nivolumab and ipilimumab in a 65-year-old male patient with stage IV lung adenocarcinoma. During treatment with chemotherapy combined with nivolumab and ipilimumab, the patient developed severe diarrhea and was later found to have autoimmune colitis, leading to a suspension of immunotherapy and initiation of steroid treatment. After a brief recovery and partial tumor regression, the patient experienced grade 3 pneumonitis upon resuming nivolumab monotherapy, necessitating intensive treatment and discontinuation of immunotherapy. Following cessation of treatment, the patient's condition remained stable with no disease progression observed over three months. ICIs can induce non-specific immune activation, resulting in widespread inflammatory effects. Early recognition and prompt treatment with high-dose steroids are essential to prevent rapid deterioration in patients experiencing immune-related adverse events (irAEs). Given the widespread use of ICIs in cancer therapy and ongoing clinical trials, there is a need for increased education on irAE and updated management algorithms for NSCLC patients.