{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T17:11:35Z","timestamp":1770225095620,"version":"3.49.0"},"reference-count":31,"publisher":"Harborside Press, LLC","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) induce profound benefits in cancer patients with mismatch repair gene mutations or high levels of microsatellite instability. Herein, we present a case of a patient with history of Muir-Torre\/Lynch syndrome and metastatic gastric adenocarcinoma in the presence of an <jats:italic>MSH2<\/jats:italic> gene mutation. The patient was initially treated with a PD-1 inhibitor, pembrolizumab, but developed grade 4 myocarditis requiring treatment with infliximab and a prolonged steroid taper. Following discontinuation of pembrolizumab, surveillance testing showed no radiographic or endoscopic evidence of progression for 7 months, until biopsy results from a repeat upper endoscopy indicated local disease recurrence. The patient was subsequently rechallenged with another PD-1 inhibitor, nivolumab, at a 50% dose reduction without recurrent adverse events and eventually achieved a complete response after 13 cycles. This case highlights the relative importance of considering careful rechallenge with ICI therapy in patients with microsatellite instability\u2013high malignancies and a high risk of severe adverse events.<\/jats:p>","DOI":"10.6004\/jnccn.2023.7029","type":"journal-article","created":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T19:32:36Z","timestamp":1694028756000},"page":"894-899","source":"Crossref","is-referenced-by-count":7,"title":["Rechallenge With Switching Immune Checkpoint Inhibitors Following Autoimmune Myocarditis in a Patient With Lynch Syndrome"],"prefix":"10.6004","volume":"21","author":[{"given":"Cody","family":"Eslinger","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Walden","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Barry","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shimoli","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niloy Jewel","family":"Samadder","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanios S.","family":"Bekaii-Saab","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4047","reference":[{"key":"B1","series-title":"Cancer Epidemiol Biomarkers Prev","first-page":"404","article-title":"Prevalence and penetrance of major genes and polygenes for colorectal cancer","volume":"26","author":"Win AK","year":"2017","unstructured":"Win AK, Jenkins MA, Dowty JG,  Prevalence and penetrance of major genes and polygenes for colorectal cancer. 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