Clinical Characteristics and Outcomes in Immune Checkpoint Inhibitor Therapy-Associated Myocarditis

Abstract

Immune checkpoint inhibitor (ICI) therapy has played an important role in the treatment of several groups of cancers. Although a life prolonging treatment, many side effects have been shown with ICI therapy. This study looked at individual level clinical characteristics and outcomes with ICI therapy in patients who developed ICI-related myocarditis. A comprehensive review of the National Library of Medicine PubMed database was performed. Inclusion criteria were all studies that were composed of case reports and case series of individual patients undergoing ICI therapy that developed myocarditis. To appreciate individual patient level data, observational studies, clinical trials, systematic reviews, and meta-analyses were excluded. Our search yielded 333 results with 71 cases reviewed of ICI therapy-related myocarditis. The findings included an average age of 68 years, higher incidence in men, and pretreatment cardiac history of hypertension. Melanoma was the most prevalent malignancy with nivolumab being the most used ICI therapy. Heart failure was the most prevalent adverse event that was co-prevalent with myocarditis. Corticosteroid therapy alone was the most utilized therapy to treat ICI-related myocarditis. Mortality was seen in nearly half of the patient population. Our study reviewed the preexisting literature of prior reported myocarditis secondary to ICI therapy. Periodic surveillance should be performed by the cardio-oncologist and internist. Due to the expanding role of ICI therapy in treating a variety of cancer pa-tients, appreciation of its impact on the development of myocarditis is needed.

Plasma exchange plus glucocorticoids in the treatment of immune checkpoint inhibitor‐induced myocarditis: A case series and review

“…Previous studies have consistently demonstrated that anti‐PD‐1 and anti‐PD‐L1 antibodies cause various adverse effects 17–19 . The main cardiotoxicity associated with anti‐PD‐1/anti‐PD‐L1 antibodies is myocarditis 20–23 …”

“… 17 , 18 , 19 The main cardiotoxicity associated with anti‐PD‐1/anti‐PD‐L1 antibodies is myocarditis. 20 , 21 , 22 , 23 …”

“…[17][18][19] The main cardiotoxicity associated with anti-PD-1/anti-PD-L1 antibodies is myocarditis. [20][21][22][23] Plasma exchange aims to rapidly remove antigens, antibodies, immune complexes, and cytokines from the plasma using a blood cell separation device, thus suppressing exaggerated cellular and humoral immunity and avoiding damage associated with over-regulated immunity. 24 Plasma exchange can supplement electrolytes, proteins, coagulation factors, and other blood components in patients.…”

Integrated Single-Cell and RNA Sequencing Analysis Identifies Key Immune Cell and Dendritic Cells Associated Genes Participated in Myocarditis

“…Myocarditis exhibited a wide spectrum of clinical manifestations, with the vast majority presenting with nonspecific systemic symptoms such as gastroenteritis, myalgia, fever, or respiratory symptoms [ 10 ], in addition to the possibility of arrhythmias, palpitations, and exertional dyspnea [ 11 , 12 ] in patients with myocarditis. This varies widely in clinical presentation leading to the diagnosis being sometimes difficult to establish, and numerous therapies for myocarditis have not demonstrated survival benefits [ 13 ]. Therefore, a lot of research is still needed to deeply analyze the underlying mechanism of myocarditis infiltration to provide the basis for the diagnosis and treatment of myocarditis.…”

Relationship Between Immune Checkpoint Inhibitors And Myocarditis

“…ICI-related myocarditis is associated with a high reported mortality [4]. A comprehensive review of ICI therapy and myocarditis has found that ICI therapy-related myocarditis occurs at an average age of 68 years, and the characteristics of the patients include higher incidence in men and pretreatment cardiac history of hypertension [5]. Especially, ICI therapy with nivolumab, an anti-programmed death protein 1 (PD-1) monoclonal antibody, had mortality in 51.9% [5].…”