Lung Cancer Immunotherapy Triggers Life-Threatening Multi-System Immune Reactions in One Patient

A 74-year-old man with stage IIIA lung squamous cell carcinoma developed overlapping immune-related adverse events affecting his muscles, heart, eyes and thyroid after just two cycles of the immune checkpoint inhibitor toripalimab combined with chemotherapy, according to a case report and literature review accepted for publication in Frontiers in Pharmacology by a team at the First Affiliated Hospital of Chengdu Medical College in Chengdu, China. The patient presented with bilateral ptosis, or drooping of both upper eyelids, and blurred vision, alongside abnormal thyroid function, elevated muscle enzymes and raised cardiac biomarkers. Clinicians diagnosed him with immune checkpoint inhibitor-induced myositis, myocarditis and thyroiditis, a life-threatening cluster of multi-system immune-related adverse events that the authors describe as posing great clinical challenges.

Immune checkpoint inhibitors have revolutionized the treatment of non-small cell lung cancer, yet the Chengdu team’s report documents how quickly a severe immune backlash can escalate in an elderly patient. After the adverse events were recognized, the immune checkpoint inhibitors were discontinued immediately. Treatment was then adjusted sequentially as the disease evolved: glucocorticoids were administered, and the anti-thyroid drug methimazole and the thyroid hormone replacement levothyroxine were given at different stages according to the patient’s changing thyroid function. The patient recovered well and went on to undergo lobectomy, the surgical removal of a lung lobe, successfully.

The authors emphasize that elderly individuals complicated by pre-existing cardiovascular diseases are particularly susceptible to severe immune-related adverse events. In this case, the cardiac involvement signaled by elevated cardiac biomarkers, the muscle injury indicated by raised muscle enzymes, and the ocular symptoms of ptosis and blurred vision appeared together rather than in isolation, illustrating why overlapping multi-system immune-related adverse events are considered life-threatening and clinically demanding. Early identification of such overlapping events, timely withdrawal of the checkpoint inhibitor and standardized immunosuppressive therapy are described by the authors as essential elements of management.

A second key lesson from the report concerns the dynamic behavior of endocrine immune-related adverse reactions. The authors note that thyroid toxicity may progress from a hyperthyroid phase to hypothyroidism, necessitating individualized monitoring and replacement therapy according to the different stages of thyroid function. This evolution is reflected in the sequential use of methimazole, an anti-thyroid drug, followed by levothyroxine, a thyroid hormone replacement, in the same patient. The report, received by the journal on 20 July 2026 and accepted on 24 September 2026, is framed as a case report and literature review, meaning the authors situate this single patient’s experience within the wider published evidence on multi-system immune-related adverse events induced by immune checkpoint inhibitors in non-small cell lung cancer. As a single case report, it documents one patient’s course and the treating team’s clinical reasoning rather than testing a treatment in a controlled study, and all claims expressed in the article are solely those of the authors, who do not necessarily represent their affiliated organizations, the publisher, the editors or the reviewers.

Subject of Research: Immune checkpoint inhibitor-induced multi-system immune-related adverse events in non-small cell lung cancer

Article Title: Immune-related adverse reactions across multiple systems in a non-small cell lung cancer patient induced by immune checkpoint inhibitors: a case report and literature review

Article References: Li, J., Wang, D., Zheng, L., Liu, C., & Jiang, T. (2026). Immune-related adverse reactions across multiple systems in a non-small cell lung cancer patient induced by immune checkpoint inhibitors: a case report and literature review. Frontiers in Pharmacology, 17, Article 1943059. https://doi.org/10.3389/fphar.2026.1943059

Image Credits: AI Generated

DOI: 10.3389/fphar.2026.1943059

Keywords: Immune-related, adverse, reactions, across, multiple, systems, non-small, cell, lung, cancer, patient, induced