After two cycles of nivolumab, a patient develops ptosis, dysphagia, neck flexion weakness and dyspnoea. CK and troponin are both raised. Which

Question

After two cycles of nivolumab, a patient develops ptosis, dysphagia, neck flexion weakness and dyspnoea. CK and troponin are both raised. Which immediate assessment best addresses the high-risk immune-toxicity overlap?

Accepted Answer

Admit, hold immunotherapy, measure respiratory mechanics and undertake concurrent cardiac evaluation

Answer

Admit for serial respiratory mechanics, deferring cardiac investigation until the CK concentration normalises

Answer

Admit for telemetry and serial troponin, deferring respiratory mechanics until antibody results return

Answer

Hold nivolumab and arrange urgent outpatient neurophysiology while starting oral pyridostigmine

Answer

Treat as isolated myositis and trend CK, repeating troponin after muscle strength improves

irAE Sialadenitis — SCE Medical Oncology MCQ

After two cycles of nivolumab, a patient develops ptosis, dysphagia, neck flexion weakness and dyspnoea. CK and troponin are both raised. Which immediate assessment best addresses the high-risk immune-toxicity overlap?