Veno-arterial extracorporeal membrane oxygenation support for cardiogenic shock secondary to immune checkpoint inhibitors.

IntroductionTremelimumab in combination with Durvalumab has recently been approved for the treatment of unresectable hepatocellular carcinoma (HCC). While immune checkpoint inhibitors (ICIs) have transformed cancer therapy, they are associated with rare but potentially fatal immune-related adverse events, including myocarditis.Case reportWe report a case of fulminant myocarditis in a 66-year-old female with advanced HCC, 38 days after initiating the Tremelimumab/Durvalumab STRIDE protocol. She presented with cardiogenic shock requiring V-A ECMO support. High-dose corticosteroid therapy resulted in full recovery of cardiac function.DiscussionICI-associated myocarditis has a reported prevalence of 1.14%, with a high rate of major adverse cardiac events. We reported a case of Tremelimumab/Durvalumab-associated myocarditis requiring mechanical circulatory support. Prompt recognition and immunosuppression were critical for recovery.ConclusionClinicians should maintain a high index of suspicion for myocarditis in patients on ICI therapy, as early intervention can be lifesaving.