A case of ivonescimab-induced myocardial and thyroid dysfunction

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Author: WU Xue ¹  LIU Haipeng ² DONG Yumei ³

Affiliation: 1.Department of Pharmacy, The Second Hospital of Lanzhou University, Lanzhou 730030, China 2.Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou 730030, China 3.Department of Medical Oncology, The Second Hospital of Lanzhou University, Lanzhou 730030, China

Keywords: Ivonescimab Myocardial injury Thyroid dysfunction Adverse drug reaction

DOI: 10.12173/j.issn.2097-4922.202607013

Reference: WU Xue,LIU Haipeng,DONG Yumei. A case of ivonescimab-induced myocardial and thyroid dysfunction[J]. Frontiers in Pharmaceutical Sciences,2026,30(10):1799-1804. DOI:10.12173/j.issn.2097-4922.202607013[Article in Chinese]  Copied

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Abstract

This article reports the case of a 67-year-old male patient with colon cancer and liver metastases who developed markedly elevated cardiac biomarkers and a biphasic evolution of thyroid function after two cycles of ivonescimab combined with the mFOLFOX6 regimen. The myocardial injury manifested solely as abnormal cardiac biomarkers (creatine kinase-MB mass 47.20 ng/mL; high-sensitivity cardiac troponin T 279.0 ng/L), without clinical symptoms such as chest tightness or chest pain or any electrocardiographic changes, and representing subclinical cardiotoxicity. The thyroid dysfunction followed a typical biphasic course of immune checkpoint inhibitor (ICI)-related thyroiditis, initially presenting as the thyrotoxic phase of destructive thyroiditis and subsequently progressing to the hypothyroid phase. Ivonescimab was discontinued, and after methylprednisolone pulse therapy and levothyroxine sodium replacement therapy, the patient's cardiac biomarker levels gradually recovered and thyroid function improved. The Naranjo's Assessment Scale was used to assess the causal relationship between ivonescimab and the above adverse reactions, yielding a score of 7, categorized as "probable". This case suggests that cardiac biomarkers and thyroid function should be incorporated into routine monitoring during ivonescimab therapy, and vigilance should be maintained against adverse reactions such as subclinical myocardial injury and thyroid dysfunction, to ensure medication safety.

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