Durvalumab-induced Myocarditis, Myositis, and Myasthenia Gravis

A Case Report

Jason Cham; Daniel Ng; Laura Nicholson


J Med Case Reports. 2021;15(278) 

In This Article


Durvalumab (MedImmune/AstraZeneca) is a human immunoglobulin G1 kappa monoclonal antibody directed against programmed cell death ligand 1 (PD-L1). It has been demonstrated to have significant antitumor activity and is FDA-approved for use in non-small cell lung cancer and urothelial carcinoma. In March 2020, approval was added for durvalumab in combination with etoposide and either carboplatin or cisplatin as a first-line treatment of patients with extensive small cell lung cancer.[1] While immune checkpoint inhibitors (ICI) are now a mainstay of treatment for numerous malignancies, they are also associated with immune-related adverse effects (irAE). The most common irAE for durvalumab are immune-mediated dermatologic reactions (1.6%), colitis (1.6%), hepatitis (1%), nephritis (0.3%), and endocrinopathies including hypothyroidism (7.3%) and hyperthyroidism (1.4%), adrenal insufficiency (0.4%), type 1 diabetes mellitus (< 0.1%), and hypopituitarism/hypophysitis (< 0.1%).[1] Here, we present a patient who developed a rare combination of adverse effects: myocarditis, myositis, and myasthenia gravis, as a result of PD-L1 inhibition with durvalumab.