Immune checkpoint inhibitor-induced myocarditis in lung cancer patients: a case report of sintilimab-induced myocarditis and a review of the literature

Abstract

Since its initial approval by the United States Food and Drug Administration (FDA) in 2014, the indications for the use of the immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC) patients has increased. However, to date, there has no report on immune myocarditis caused by the ICI sintilimab. In addition, there has been no literature review on ICI-induced myocarditis in lung cancer patients. This is a case report of an elderly male patient who presented with a productive cough and progressive dysphagia for 3 days. The symptoms started on day 6 after the third cycle of sintilimab treatment for his lung carcinoma. In accordance with his clinical manifestations of progressive dysphagia, a previous history of lung cancer, abnormal electrocardiograph, significantly increased serum myocardial enzyme levels, and normal coronary angiography results, sintilimab-induced myocarditis was diagnosed.Methylprednisolone (80-40 mg) was used to inhibit the immune injury and the patient was safely discharged on the 13th day following admission. Since ICI-induced myocarditis is rare and fatal, we summarized the characteristics of 20 cases of the disease in lung cancer patients to highlight to oncologists, respiratory experts, and cardiologists the serious side effects of the drug when they encounter lung cancer patients using ICIs. Like most ICIs, sintilimab induces severe immune myocarditis and requires corticosteroids therapy, and this should be recognized by doctors in multiple departments.

Cardiovascular toxicities associated with immune checkpoint inhibitors: An updated comprehensive disproportionality analysis of the FDA adverse event reporting system

“…We included 13,713 cases of ICI‐associated cardiovascular diseases, the largest such collection of cases to date, suggesting that cardiovascular AEs under ICIs appear less rare than initially thought 7 . The cardiovascular toxicities of ICI have been reported in some case reports and one study, but the cardiovascular toxicities, the onset time, clinical characteristics, fatality and hospitalization between different ICI regimens are unknown 4–7 . Here, this study showed that the myocardial and pericardial disorders were the both two strong signals significantly associated with all anti‐PD‐1 and anti‐PD‐L1 monotherapy, with the exception of anti‐CTLA‐4 monotherapy, revealing differences of myocardial and pericardial disorders between anti‐PD‐1/PD‐L1 and anti‐CTLA‐4 monotherapy.…”

“…Whereas, the increased prevalence of ICI use and movement toward combined ICI blockade have raised concerns for concomitant autoimmune toxicities. Recently, emerging case reports have raised awareness of cardiovascular toxicities from ICI monotherapy and combination 4–6 . Few studies have systematically focused on cardiovascular toxicities induced by ICIs.…”

Sintilimab-Induced Myocarditis Overlapping Myositis in a Patient With Metastatic Thymoma: A Case Report

“…A phase 2 study of pembrolizumab observed a higher incidence of cardiac and muscular abnormalities in patients with thymic carcinoma and a notable predilection to Asians. ( 6 ) Two recently reported cases of sintilimab-induced myocarditis and myositis or MG demonstrated some similarities in clinical pattern with other ICIs ( 7 , 8 ). Comparatively, the current case showed an early onset after the first dose, a preceding asymptomatic period, a dramatic change of ECG, and a better outcome in a younger patient.…”

Sintilimab induced ICIAM in the treatment of advanced HCC: A case report and analysis of research progress

“…Huang et al reported in a study that 48 patients with various advanced tumors were treated with sintilimab, and one of them developed ICIAM (G1) (13). Huan Bi et al reported a case with lung squamous cell carcinoma (SCC) that developed ICIAM within 6 days plus three cycles after receiving sintilimab treatment (21 days/cycle) (14). Chen and Liang et al reported the case of ICIAM in a chordoma patient who received sintilimab plus anlotinib treatment respectively (15,16).…”