Toripalimab can induce myositis, myocarditis, and thyroiditis in patients with non-small cell lung cancerToripalimab Treatment Linked to Heart and Muscle Inflammation

Frontiers in Medicine Published October 24, 2026 DOI ↗ Editorial oversight: Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

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Key Takeaway

Monitor elderly patients on toripalimab for severe irAEs including myocarditis, myositis, and thyroiditis.

This case report and literature review describes a single case of a 74-year-old male with stage IIIA lung squamous cell carcinoma treated with toripalimab and chemotherapy. The patient developed multiple immune-related adverse events (irAEs), specifically myositis, myocarditis, and thyroiditis. Additional reported adverse events included bilateral ptosis, blurred vision, abnormal thyroid function, elevated muscle enzymes, and cardiac biomarkers.

The authors note that toripalimab was discontinued immediately upon the diagnosis of these irAEs. The review highlights that elderly patients with pre-existing cardiovascular diseases are particularly susceptible to severe irAEs. Furthermore, the authors note that thyroid toxicity may progress from a hyperthyroid to a hypothyroid phase.

Due to the nature of this report as a single case and literature review, the evidence is limited and does not represent a large-scale clinical trial. However, it underscores the necessity of monitoring for multi-organ irAEs in patients receiving immune checkpoint inhibitors. Clinical relevance is centered on the potential for severe, multi-system complications in elderly populations.

How this fits prior evidence

This case report highlights the risk of severe immune-related adverse events (irAEs) such as myocarditis and myositis following checkpoint inhibitor therapy. While it does not directly relate to the previously reported cases of pembrolizumab-induced hypophysitis or icotinib-related myeloid neoplasms, it addresses the broader clinical challenge of managing irAEs in patients with non-small cell lung cancer. It reinforces the need for vigilant monitoring of cardiovascular and endocrine functions in elderly patients receiving toripalimab.

A case report describes a 74-year-old man with non-small cell lung cancer who received toripalimab combined with chemotherapy. During treatment, the patient developed several immune-related side effects, including myositis, myocarditis, and thyroiditis. These conditions were linked to the use of immune checkpoint inhibitors.

In addition to these conditions, the patient experienced blurred vision, drooping eyelids, and abnormal thyroid function. Doctors noted that thyroid issues can progress from a hyperthyroid phase to a hypothyroid phase. The toripalimab treatment was stopped immediately once these immune-related events were identified.

Because this is a single case report and a literature review, the findings are not enough to establish a broad rule for all patients. However, it highlights that elderly patients with existing heart issues may be at higher risk for severe reactions. Patients should discuss these specific risks with their doctor to manage potential side effects.

What this means for you:

One case shows toripalimab can cause heart, muscle, and thyroid issues in some patients with lung cancer.

Common questions

What side effects were seen with toripalimab?

In this specific case, the patient developed myositis, myocarditis, and thyroiditis. Other reported issues included blurred vision, bilateral ptosis, and elevated muscle enzymes. These are known as immune-related adverse events caused by the medication.

Who is most at risk for these complications?

The report suggests that elderly individuals, especially those with pre-existing cardiovascular diseases, may be more susceptible to severe immune-related adverse events. These patients may need closer monitoring during treatment.

What happened to the patient's thyroid function?

The patient showed abnormal thyroid function. The report notes that thyroid toxicity can progress from a hyperthyroid phase to a hypothyroid phase. The medication was stopped immediately upon diagnosis of these issues.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedOct 2026

View Original Abstract ↓

BackgroundImmune checkpoint inhibitors (ICIs) have revolutionized the treatment of non-small cell lung cancer (NSCLC), while overlapping multi-system immune-related adverse events (irAEs) are life-threatening and pose great clinical challenges.Case DescriptionA 74-year-old male patient with stage IIIA lung squamous cell carcinoma developed bilateral ptosis, blurred vision, abnormal thyroid function, elevated muscle enzymes and cardiac biomarkers after two cycles of toripalimab combined with chemotherapy. He was diagnosed with ICI-induced myositis, myocarditis and thyroiditis. ICIs were discontinued immediately. Glucocorticoids, methimazole and levothyroxine were administered sequentially according to disease progression. The patient recovered well and underwent lobectomy successfully.ConclusionElderly individuals complicated with pre-existing cardiovascular diseases are susceptible to severe immune-related adverse events. Early identification of overlapping multi-system irAEs, timely drug withdrawal and standardized immunosuppressive therapy are essential. Endocrine-immune-related adverse reactions exhibit dynamic evolution; for instance, thyroid toxicity may progress from a hyperthyroid phase to hypothyroidism, necessitating individualized monitoring and replacement therapy according to different stages of thyroid function.

Toripalimab can induce myositis, myocarditis, and thyroiditis in patients with non-small cell lung cancerToripalimab Treatment Linked to Heart and Muscle Inflammation

How this fits prior evidence

Common questions

Study Details

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Toripalimab can induce myositis, myocarditis, and thyroiditis in patients with non-small cell lung cancerToripalimab Treatment Linked to Heart and Muscle Inflammation

How this fits prior evidence

Common questions

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Study Details

Mazdutide monotherapy reduces HbA1c and promotes weight loss in Chinese adults with type 2 diabetes over 48 weeks

New Drug Lowers Sugar and Shrinks Weight in Diabetes

Clinical research that matters. Delivered to your inbox.

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