{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:19:44Z","timestamp":1793225984169,"version":"4.5.0"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>\n                    Immune checkpoint inhibitors (ICI) have revolutionized melanoma treatment but are associated with autoimmune toxicities. Immunotherapy-induced pneumonitis (IIP) is a potentially fatal immune-related adverse event. Current management of IIP involves corticosteroids, mycophenolate mofetil (MMF), intravenous immunoglobulin, or infliximab for severe cases. Limited data exist for corticosteroid-refractory pneumonitis. This case report is the first to describe successful treatment of refractory grade 4 IIP with equine antithymocyte globulin (eATG) after failure of corticosteroids and MMF. A 50-year-old woman with recurrent unresectable melanoma in the right ankle developed grade 4 IIP after receiving two cycles of ipilimumab and nivolumab. Despite intravenous high-dose corticosteroid and MMF, her clinical condition continued to rapidly deteriorate. eATG was administered due to its rapid onset of T lymphocyte depletion and its use in immunotherapy-induced myocarditis. An 8-day course was delivered with dose adjustment to achieve therapeutic CD2\n                    <jats:sup>+<\/jats:sup>\n                    \/CD3\n                    <jats:sup>+<\/jats:sup>\n                    lymphocyte depletion. Clinical and radiological improvement was demonstrated, with successful weaning of oxygen and corticosteroids. At 12 months, the patient remained well from a respiratory standpoint, with no recurrence of melanoma. This case highlights the potential for eATG, with therapeutic CD2\n                    <jats:sup>+<\/jats:sup>\n                    \/CD3\n                    <jats:sup>+<\/jats:sup>\n                    T lymphocyte count monitoring, to address an unmet therapeutic need in patients with refractory ICI-induced IIP.\n                  <\/jats:p>","DOI":"10.3389\/fonc.2026.1801207","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T05:23:43Z","timestamp":1773897823000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Successful treatment of steroid-refractory severe immunotherapy-induced pneumonitis with equine antithymocyte globulin"],"prefix":"10.3389","volume":"16","author":[{"given":"Thi Thao Vi","family":"Luong","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Alfred Health","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindon","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Alfred Health","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Coutsouvelis","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Alfred Health","place":["Melbourne, VIC, Australia"]},{"name":"Centre for Medicine Use and Safety, Monash University","place":["Parkville, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli","family":"Dabscheck","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Alfred Health","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Ivulich","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Alfred Health","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Burridge","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Alfred Health","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Keating","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Alfred Health","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Shackleton","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Alfred Health","place":["Melbourne, VIC, Australia"]},{"name":"Department of Cancer Medicine, School of Translational Medicine, Monash University","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Haydon","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Alfred Health","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miles C.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Alfred Health","place":["Melbourne, VIC, Australia"]},{"name":"Department of Cancer Medicine, School of Translational Medicine, Monash University","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3998","DOI":"10.1200\/JCO.22.01599","article-title":"Seven-year follow-up of the phase III KEYNOTE-006 study: pembrolizumab versus ipilimumab in advanced melanoma","volume":"41","author":"Robert","year":"2023","journal-title":"J Clin Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.3923","article-title":"Fatal toxic effects associated with immune checkpoint inhibitors: A systematic review and meta-analysis","volume":"4","author":"Wang","year":"2018","journal-title":"JAMA Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.2453","article-title":"Incidence of programmed cell death 1 inhibitor-related pneumonitis in patients with advanced cancer: A systematic review and meta-analysis","volume":"2","author":"Nishino","year":"2016","journal-title":"JAMA Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.02.032","article-title":"Immune checkpoint inhibitor-related pneumonitis in lung cancer: real-world incidence, risk factors, and management practices across six health care centers in North Carolina","volume":"160","author":"Atchley","year":"2021","journal-title":"Chest"},{"key":"B5","doi-asserted-by":"publisher","first-page":"100969","DOI":"10.1016\/j.resmer.2022.100969","article-title":"Prevalence and outcome of steroid-resistant\/refractory pneumonitis induced by immune checkpoint inhibitors","volume":"82","author":"Camard","year":"2022","journal-title":"Respir Med Res"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2020-001884","article-title":"Success and failure of additional immune modulators in steroid-refractory\/resistant pneumonitis related to immune checkpoint blockade","volume":"9","author":"Beattie","year":"2021","journal-title":"J Immunother Cancer"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/CJI.0000000000000239","article-title":"Autoimmune myocarditis caused by immune checkpoint inhibitors treated with antithymocyte globulin","volume":"41","author":"Jain","year":"2018","journal-title":"J Immunother"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1266850","article-title":"Immune checkpoint inhibitor-related pneumonitis: research advances in prediction and management","volume":"15","author":"Lin","year":"2024","journal-title":"Front Immunol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1007\/s00262-024-03902-3","article-title":"Cytokine profile of bronchoalveolar lavage in patients with and without checkpoint inhibitor pneumonitis","volume":"74","author":"Ploch","year":"2025","journal-title":"Cancer Immunol Immunother"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/1759-7714.15385","article-title":"Risk factors for severe immune-related pneumonitis after nivolumab plus ipilimumab therapy for non-small cell lung cancer","volume":"15","author":"Sumi","year":"2024","journal-title":"Thorac Cancer"},{"key":"B11","doi-asserted-by":"publisher","first-page":"113140","DOI":"10.1016\/j.intimp.2024.113140","article-title":"The predict factors and clinical prognosis value of immune-related pneumonia of receiving PD-1 inhibitor in advanced non-small cell lung cancer: A retrospective study","volume":"142","author":"Yang","year":"2024","journal-title":"Int Immunopharmacol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/s12885-025-15460-7","article-title":"Using routine blood tests to predict severe immune-related adverse events during immune checkpoint inhibitor treatment","volume":"26","author":"Acar","year":"2025","journal-title":"BMC Cancer"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e01356","DOI":"10.1002\/rcr2.1356","article-title":"Effective treatment of steroid-resistant immune checkpoint inhibitor pneumonitis with mycophenolate mofetil","volume":"12","author":"Shioiri","year":"2024","journal-title":"Respirol Case Rep"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2020-001731","article-title":"Steroid-refractory PD-(L)1 pneumonitis: incidence, clinical features, treatment, and outcomes","volume":"9","author":"Balaji","year":"2021","journal-title":"J Immunother Cancer"},{"key":"B15","doi-asserted-by":"publisher","first-page":"5211","DOI":"10.1182\/blood-2018-99-117353","article-title":"A retrospective review of tocilizumab for the management of blinatumomab (a bispecific T cell engager)-induced cytokine release syndrome (CRS)","volume":"132","author":"Choudhry","year":"2018","journal-title":"Blood"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2017.253","article-title":"Successful use of equine anti-thymocyte globulin (ATGAM) for fulminant myocarditis secondary to nivolumab therapy","volume":"117","author":"Tay","year":"2017","journal-title":"Br J Cancer"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1527690","article-title":"Immunotherapy rechallenge after ICI-related pneumonitis in lung cancer patients: a retrospective cohort study","volume":"15","author":"Wu","year":"2025","journal-title":"Front Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1801207\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T05:23:43Z","timestamp":1773897823000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1801207\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,19]]},"references-count":17,"alternative-id":["10.3389\/fonc.2026.1801207"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1801207","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,19]]},"article-number":"1801207"}}