Management of multisystemic irAEs associated with atezolizumab/tiragolumab combination therapy in a patient with lung adenocarcinoma: case report and review

Abstract Immune checkpoint inhibitors (ICIs), including anti-PD-1/L1 therapies, have revolutionized the treatment of various malignancies, but immune resistance limits their effectiveness. Although combination therapy with ICIs or agonists can enhance therapeutic efficacy, this can also cause more complex and severe immune-related adverse events (irAEs) in vital organs and affect other tissues. Multisystem irAEs caused by tiragolumab, a novel anti-T cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif domain (TIGIT) inhibitor, have been rarely reported. Thus, we present the first reported case of ICI-induced multisystemic adverse events in a patient with lung adenocarcinoma treated with the anti-PD-L1 drug atezolizumab and anti-TIGIT drug tiragolumab in a clinical trial. After completing a single cycle of anti-PD-L1 plus anti-TIGIT as first-line treatment, the patient complained of persistent weakness and myalgia, which were followed by chest pain, dyspnea, and markedly elevated laboratory parameters such as troponin and cytokines. He was diagnosed with ICI-induced myocarditis, along with hepatic injury, thrombocytopenia, and dermatomyositis. Then, the patient exhibited stable disease control following a regimen of treatments, including systemic methylprednisolone, immunoglobulin, tofacitinib, and supportive care. This case underscores the importance of a deeper understanding of multisystemic irAEs and timely intervention when employing a combination of ICIs, particularly anti-PD-L1 plus anti-TIGIT therapy.