Clinical insights: atezolizumab-induced myositis mimicking hepatic injury

Atezolizumab is an immune checkpoint inhibitor that targets PDL-1 (programmed death ligand-1) on the tumour cells and inactivates it. The addition of this drug to chemotherapy has led to survival benefits in the treatment of small cell lung cancer-extensive stage (SCLC-ES). However, these excellent outcomes may be marred by the development of immune-mediated adverse events (irAEs). The pathophysiology of these irAEs is not well defined, and as a result, they are less understood as an entity. In addition to this, the highly non-specific presentation and unawareness among treating physicians may lead to delays in diagnosis and subsequently affect patient outcomes. Immunotherapy-induced myositis is one such rare irAE. Herein, we present a case of a male in his early 70 s undergoing treatment for SCLC-ES, who initially presented with non-specific symptoms and grade four transaminitis and was subsequently diagnosed with atezolizumab-related myositis after comprehensive evaluation. The patient was managed successfully and has an ongoing response more than 6 months after stopping immunotherapy and 18 months since initial diagnosis. This case report aims to address the knowledge gap regarding this irAE with insights on diagnosis and management.