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January-2026 Volume 31 Issue 1

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Case Report Open Access

Dual immune checkpoint inhibitor cardonilumab induces immune myocarditis in a patient with cancer‑related myocardial metastasis: A case report

  • Authors:
    • Tianxing Liu
    • Qiang Li
    • Renya Zeng
    • Baidong Zhang
    • Zhichao Kang
    • Pengfei Zhang
    • Zhe Yang
  • View Affiliations / Copyright

    Affiliations: Qilu College of Medicine, Shandong University, Shandong Provincial Hospital, Jinan, Shandong 250021, P.R. China, Cancer Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China, School of Clinical Medicine, Shandong First Medical University, Shandong Provincial Hospital, Jinan, Shandong 250021, P.R. China
    Copyright: © Liu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 30
    |
    Published online on: November 12, 2025
       https://doi.org/10.3892/ol.2025.15383
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Abstract

Cadonilimab is a bispecific immune checkpoint inhibitor (ICI) targeting both programmed death 1 and cytotoxic T‑lymphocyte activator 4, thus blocking both immune checkpoint pathways. Cadonilimab exerts several antitumor effects and is used to treat various types of cancer, including gastric, liver, lung, cervical and pancreatic cancer, and esophageal squamous cell carcinoma. However, ICIs are also associated with the onset of several immune‑related adverse events (irAEs), including immune‑mediated pneumonia, immune‑mediated colitis and myocarditis. Among them, myocarditis is a rare but potentially life‑threatening side effect. The current study describes the case of a 49‑year‑old patient with lung cancer and myocardial metastasis, who developed myocarditis and heart failure following therapy with cadonilimab. After three cycles of cadonilimab treatment for 2 months, the patient experienced persistent wheezing and a paroxysmal cough, prompting hospitalization. Multidisciplinary assessment and laboratory findings supported a diagnosis of immune‑related myocarditis. Following treatment with low‑dose diuretics and intravenous methylprednisolone (adjusted dose), and management of anemia, the patient recovered well and was discharged on hospital day 21. This case study highlights the importance of vigilance for severe cardiovascular complications associated with dual ICI cadonilimab immunotherapy. Therefore, close outpatient monitoring is critical during treatment with cadonilimab, with particular attention awarded to the overall condition of the patients. Special consideration should be given to risk factors, such as cardiac metastasis and impaired lung function, which could predispose patients to irAEs associated with immunotherapy, and more particularly with myocarditis. Based on the current experience, the present study offers practical recommendations for the prevention of cadonilimab‑induced myocarditis to improve patient outcomes.
View Figures

Figure 1

Pathological and immunohistochemical
staining. Upper panel: Pathological section of the pulmonary lesion
(hematoxylin and eosin staining; ×20 magnification). Lower panel:
Immunohistochemical analysis of programmed death ligand 1
expression (×20 magnification).

Figure 2

Postoperative chest computed
tomography scan of the primary lesion. The red arrow on the left
indicates pleural effusion, while the red arrow on the right
denotes mediastinal lymphadenopathy.

Figure 3

Chest computed tomography findings
from January 2021. The red arrow indicates nodular pleural
thickening in the left lung. The yellow arrow indicates multiple
enlarged lymph nodes in the mediastinum and bilateral hilar
regions.

Figure 4

Magnetic resonance imaging showing
myocardial metastasis. The upper image demonstrates tumor and
pericardial effusion on T2-weighted imaging, while the lower image
shows apparent diffusion coefficient mapping. The red arrows
indicate areas of focal myocardial thickening with diffuse abnormal
signal intensity and contrast enhancement, suggestive of metastatic
lesions.

Figure 5

Histopathological image of the gluteal
soft-tissue mass (H&E staining; ×20 magnification).

Figure 6

Timeline of three cardiac biomarkers
during hospitalization. The levels of pro-BNPand HS-TnT are shown.
Dotted lines represent the upper normal range. Pro-BNP, pro-B-type
natriuretic peptide; HS-TnT, high-sensitivity cardiac troponin
T.

Figure 7

Electrocardiogram suggestive of
possible ectopic atrial rhythm.

Figure 8

Chronology of key events.
View References

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Copy and paste a formatted citation
Spandidos Publications style
Liu T, Li Q, Zeng R, Zhang B, Kang Z, Zhang P and Yang Z: Dual immune checkpoint inhibitor cardonilumab induces immune myocarditis in a patient with cancer‑related myocardial metastasis: A case report. Oncol Lett 31: 30, 2026.
APA
Liu, T., Li, Q., Zeng, R., Zhang, B., Kang, Z., Zhang, P., & Yang, Z. (2026). Dual immune checkpoint inhibitor cardonilumab induces immune myocarditis in a patient with cancer‑related myocardial metastasis: A case report. Oncology Letters, 31, 30. https://doi.org/10.3892/ol.2025.15383
MLA
Liu, T., Li, Q., Zeng, R., Zhang, B., Kang, Z., Zhang, P., Yang, Z."Dual immune checkpoint inhibitor cardonilumab induces immune myocarditis in a patient with cancer‑related myocardial metastasis: A case report". Oncology Letters 31.1 (2026): 30.
Chicago
Liu, T., Li, Q., Zeng, R., Zhang, B., Kang, Z., Zhang, P., Yang, Z."Dual immune checkpoint inhibitor cardonilumab induces immune myocarditis in a patient with cancer‑related myocardial metastasis: A case report". Oncology Letters 31, no. 1 (2026): 30. https://doi.org/10.3892/ol.2025.15383
Copy and paste a formatted citation
x
Spandidos Publications style
Liu T, Li Q, Zeng R, Zhang B, Kang Z, Zhang P and Yang Z: Dual immune checkpoint inhibitor cardonilumab induces immune myocarditis in a patient with cancer‑related myocardial metastasis: A case report. Oncol Lett 31: 30, 2026.
APA
Liu, T., Li, Q., Zeng, R., Zhang, B., Kang, Z., Zhang, P., & Yang, Z. (2026). Dual immune checkpoint inhibitor cardonilumab induces immune myocarditis in a patient with cancer‑related myocardial metastasis: A case report. Oncology Letters, 31, 30. https://doi.org/10.3892/ol.2025.15383
MLA
Liu, T., Li, Q., Zeng, R., Zhang, B., Kang, Z., Zhang, P., Yang, Z."Dual immune checkpoint inhibitor cardonilumab induces immune myocarditis in a patient with cancer‑related myocardial metastasis: A case report". Oncology Letters 31.1 (2026): 30.
Chicago
Liu, T., Li, Q., Zeng, R., Zhang, B., Kang, Z., Zhang, P., Yang, Z."Dual immune checkpoint inhibitor cardonilumab induces immune myocarditis in a patient with cancer‑related myocardial metastasis: A case report". Oncology Letters 31, no. 1 (2026): 30. https://doi.org/10.3892/ol.2025.15383
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