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Life sciences · Journal article
Frontiers in Pharmacology · October 23, 2026
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Background Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of non-small cell lung cancer (NSCLC), while overlapping multi-system immune-related adverse events (irAEs) are life-threatening and pose great clinical challenges. Case Description A 74-year-old male patient with stage IIIA lung squamous cell carcinoma developed bilateral ptosis, blurred vision, abnormal thyroid function, elevated muscle enzymes and cardiac biomarkers after two cycles of toripalimab combined with chemotherapy. He was diagnosed with ICI-induced myositis, myocarditis and thyroiditis. ICIs were discontinued immediately. Glucocorticoids, methimazole and levothyroxine were administered sequentially according to disease progression. The patient recovered well and underwent lobectomy successfully. Conclusion Elderly individuals complicated with pre-existing cardiovascular diseases are susceptible to severe immune-related adverse events. Early identification of overlapping multi-system irAEs, timely drug withdrawal and standardized immunosuppressive therapy are essential. Endocrine-immune-related adverse reactions exhibit dynamic evolution; for instance, thyroid toxicity may progress from a hyperthyroid phase to hypothyroidism, necessitating individualized monitoring and replacement therapy according to different stages of thyroid function.