{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:40:26Z","timestamp":1777876826729,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Med Oncol"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>Sarcomatoid malignant pleural mesothelioma (MPM) is a rare and aggressive cancer with limited therapeutic options. We describe an exceptionally rare case of sarcomatoid MPM in a man in his 50s who developed three severe immune-related adverse events (irAEs)\u2014Grade 3 pneumonitis, Grade 3 hepatitis, and Grade 4 agranulocytosis\u2014within 55\u2009days of initiating nivolumab plus ipilimumab. Corticosteroid treatment and granulocyte colony-stimulating factor resulted in recovery from these toxicities, while two liver biopsies provided essential diagnostic insights, distinguishing drug-induced liver injury from immune-related hepatitis. Despite receiving only a limited number of immune checkpoint inhibitor doses and discontinuing therapy, the patient exhibited rapid pleural tumor regression and sustained clinical benefit. This case highlights the potential association between severe immune-related side effects and favorable treatment response in MPM, and underscores the importance of pathology-supported diagnosis and shared decision-making in managing complex irAEs.<\/jats:p>","DOI":"10.1177\/17588359251397331","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T14:18:23Z","timestamp":1764857903000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early severe immune-related pneumonitis, hepatitis, and agranulocytosis with radiographic response in sarcomatoid malignant pleural mesothelioma treated with nivolumab and ipilimumab: a case report highlighting dual liver biopsies and rechallenge decision-making"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1500-5215","authenticated-orcid":false,"given":"Tomohiro","family":"Oba","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuhiro","family":"Itogawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, Tokyo, Japan"},{"name":"Department of Respiratory Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoko","family":"Machida","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuji","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuho","family":"Morita","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Nakatani","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiichi","family":"Akasaka","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akiko","family":"Adachi","sequence":"additional","affiliation":[{"name":"Department of Pathology, Japanese Red Cross Saitama Hospital, Saitama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidekazu","family":"Matsushima","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"WHO Classification of Tumours Editorial Board. 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