Abstract:BackgroundImmune checkpoint inhibitors have revolutionized treatment and improved survival in many cancers. However, since immune-related adverse events (irAEs) are potentially fatal, early recognition and prompt treatment are warranted. One of the rarest but most dramatic irAE is myocarditis, which has significant morbidity and mortality if not recognized and treated early.ObjectiveTo report the first case of myocarditis in a patient with metastatic castration-resistant prostate cancer (mCRPC) treated with a … Show more
“…Among 101 severe cases of immune checkpoint inhibitor‐associated myocarditis, the median time to onset was 27 days (range, 5–155), with 64% of cases occurring after just one or two doses. Death occurred in 46 of the 101 cases, and fatality rates were highest with combination therapy.Patients presenting with myocarditis often have an abnormal ECG and elevated levels of the cardiac biomarker troponin I . Monge et al suggest an ECG, two‐dimensional‐echocardiogram, and assessment of troponin I levels prior to treatment initiation, then assessment of troponin I levels at 2, 4, and 12 weeks post‐treatment, and then monthly .…”
Section: Resultsmentioning
confidence: 99%
“…Death occurred in 46 of the 101 cases, and fatality rates were highest with combination therapy.Patients presenting with myocarditis often have an abnormal ECG and elevated levels of the cardiac biomarker troponin I . Monge et al suggest an ECG, two‐dimensional‐echocardiogram, and assessment of troponin I levels prior to treatment initiation, then assessment of troponin I levels at 2, 4, and 12 weeks post‐treatment, and then monthly . Patients with an elevated troponin I level should be further evaluated (e.g., with cardiac magnetic resonance imaging [CMRI] or myocardial biopsy) for possible myocarditis .…”
Section: Resultsmentioning
confidence: 99%
“…Monge et al suggest an ECG, two‐dimensional‐echocardiogram, and assessment of troponin I levels prior to treatment initiation, then assessment of troponin I levels at 2, 4, and 12 weeks post‐treatment, and then monthly . Patients with an elevated troponin I level should be further evaluated (e.g., with cardiac magnetic resonance imaging [CMRI] or myocardial biopsy) for possible myocarditis . Immune checkpoint inhibitor therapy should be immediately discontinued if myocarditis is suspected, and treatment with high‐dose steroids may minimize myocardial injury .…”
Section: Resultsmentioning
confidence: 99%
“…Patients with an elevated troponin I level should be further evaluated (e.g., with cardiac magnetic resonance imaging [CMRI] or myocardial biopsy) for possible myocarditis . Immune checkpoint inhibitor therapy should be immediately discontinued if myocarditis is suspected, and treatment with high‐dose steroids may minimize myocardial injury .…”
Cardiac monitoring is becoming an important part of breast cancer care. Breast cancer and cardiovascular disease (CVD) share many common risk factors, and it is estimated that by the median age of diagnosis, many patients with breast cancer will have established or subclinical CVD. In addition, a number of treatments for metastatic breast cancer are known to have cardiac effects. As such, there is a clear need to prevent, identify, and effectively manage cardiovascular events in patients with breast cancer. Current clinical practice for patients with metastatic breast cancer involves a comprehensive set of assessments to ensure efficacy and safety of treatment. Adding cardiac monitoring to the assessments already required for patients with breast cancer may improve survival and quality of life. Currently, cardiac monitoring is recommended for several breast cancer treatments, and guidelines related to cardiac monitoring are available. Here, we review the risk of CVD in patients with breast cancer, providing an overview of the cardiac events associated with standard therapies for metastatic breast cancer. We also assess the current clinical recommendations relating to cardiac monitoring, and practical management strategies for oncologists. Cardio‐oncology is a growing medical subspecialty that promotes the need for effective cancer therapy while minimizing cardiac effects. Integrating cardiac monitoring into routine clinical practice may safeguard patients with metastatic breast cancer against adverse cardiac effects.
Implications for Practice
This review details the common risk factors associated with cardiovascular disease that are frequently observed in patients with metastatic breast cancer, as well as the adverse cardiac effects of many therapies that are commonly prescribed. The review also provides a rationale for routine and comprehensive cardiovascular assessment of all patients at baseline, and during and after therapy depending on the treatment and presence of risk factors for cardiovascular disease. The medical discipline of cardio‐oncology is increasingly being recognized as an important part of clinical practice to ensure effective cancer therapy while maintaining cardiac health.
“…Among 101 severe cases of immune checkpoint inhibitor‐associated myocarditis, the median time to onset was 27 days (range, 5–155), with 64% of cases occurring after just one or two doses. Death occurred in 46 of the 101 cases, and fatality rates were highest with combination therapy.Patients presenting with myocarditis often have an abnormal ECG and elevated levels of the cardiac biomarker troponin I . Monge et al suggest an ECG, two‐dimensional‐echocardiogram, and assessment of troponin I levels prior to treatment initiation, then assessment of troponin I levels at 2, 4, and 12 weeks post‐treatment, and then monthly .…”
Section: Resultsmentioning
confidence: 99%
“…Death occurred in 46 of the 101 cases, and fatality rates were highest with combination therapy.Patients presenting with myocarditis often have an abnormal ECG and elevated levels of the cardiac biomarker troponin I . Monge et al suggest an ECG, two‐dimensional‐echocardiogram, and assessment of troponin I levels prior to treatment initiation, then assessment of troponin I levels at 2, 4, and 12 weeks post‐treatment, and then monthly . Patients with an elevated troponin I level should be further evaluated (e.g., with cardiac magnetic resonance imaging [CMRI] or myocardial biopsy) for possible myocarditis .…”
Section: Resultsmentioning
confidence: 99%
“…Monge et al suggest an ECG, two‐dimensional‐echocardiogram, and assessment of troponin I levels prior to treatment initiation, then assessment of troponin I levels at 2, 4, and 12 weeks post‐treatment, and then monthly . Patients with an elevated troponin I level should be further evaluated (e.g., with cardiac magnetic resonance imaging [CMRI] or myocardial biopsy) for possible myocarditis . Immune checkpoint inhibitor therapy should be immediately discontinued if myocarditis is suspected, and treatment with high‐dose steroids may minimize myocardial injury .…”
Section: Resultsmentioning
confidence: 99%
“…Patients with an elevated troponin I level should be further evaluated (e.g., with cardiac magnetic resonance imaging [CMRI] or myocardial biopsy) for possible myocarditis . Immune checkpoint inhibitor therapy should be immediately discontinued if myocarditis is suspected, and treatment with high‐dose steroids may minimize myocardial injury .…”
Cardiac monitoring is becoming an important part of breast cancer care. Breast cancer and cardiovascular disease (CVD) share many common risk factors, and it is estimated that by the median age of diagnosis, many patients with breast cancer will have established or subclinical CVD. In addition, a number of treatments for metastatic breast cancer are known to have cardiac effects. As such, there is a clear need to prevent, identify, and effectively manage cardiovascular events in patients with breast cancer. Current clinical practice for patients with metastatic breast cancer involves a comprehensive set of assessments to ensure efficacy and safety of treatment. Adding cardiac monitoring to the assessments already required for patients with breast cancer may improve survival and quality of life. Currently, cardiac monitoring is recommended for several breast cancer treatments, and guidelines related to cardiac monitoring are available. Here, we review the risk of CVD in patients with breast cancer, providing an overview of the cardiac events associated with standard therapies for metastatic breast cancer. We also assess the current clinical recommendations relating to cardiac monitoring, and practical management strategies for oncologists. Cardio‐oncology is a growing medical subspecialty that promotes the need for effective cancer therapy while minimizing cardiac effects. Integrating cardiac monitoring into routine clinical practice may safeguard patients with metastatic breast cancer against adverse cardiac effects.
Implications for Practice
This review details the common risk factors associated with cardiovascular disease that are frequently observed in patients with metastatic breast cancer, as well as the adverse cardiac effects of many therapies that are commonly prescribed. The review also provides a rationale for routine and comprehensive cardiovascular assessment of all patients at baseline, and during and after therapy depending on the treatment and presence of risk factors for cardiovascular disease. The medical discipline of cardio‐oncology is increasingly being recognized as an important part of clinical practice to ensure effective cancer therapy while maintaining cardiac health.
Immune checkpoint inhibitors (ICIs) that target cytotoxic T lymphocyte antigen 4, programmed cell death-1, and PD-ligand 1 have revolutionized cancer treatment, achieving unprecedented efficacy in multiple malignancies. ICIs are increasingly being used in early cancer settings and in combination with various other types of therapies, including targeted therapy, radiotherapy, and chemotherapy. However, despite the excellent therapeutic effect of ICIs, these medications typically result in a broad spectrum of toxicity reactions, termed immune-related adverse events (irAEs). Of all irAEs, cardiotoxicity, uncommon but with high mortality, has not been well recognized. Herein, based on previous published reports and current evidence, we summarize the incidence, diagnosis, clinical manifestations, underlying mechanisms, treatments, and outcomes of ICI-associated cardiotoxicity and discuss possible management strategies. A better understanding of these characteristics is critical to managing patients with ICI-associated cardiotoxicity.
Background. The development of immune checkpoint inhibitors (ICI) represents a paradigm shift in the treatment of cancers. Despite showing remarkable efficacy, these agents can be associated with life-threatening immunerelated adverse events. In recent years, several cases of myocarditis with myositis and/or myasthenia gravis overlap syndrome (IM3OS) have been reported. However, given the rarity, the clinical features and outcomes of these cases remain poorly understood. We, therefore, attempted to systematically review and summarize all cases of IM3OS reported in the literature. Methods. Studies reporting IM3OS were identified in Embase and MEDLINE. Only case reports and case series published in journals or presented at conferences were included. We conducted a systematic review according to the PRISMA Harms guidelines.Results. A total of 60 cases were eligible. The patients' median age was 71 years, and the majority (67%) were males; melanoma was the most common indication for ICI (38%). The most-reported symptom was fatigue (80%) and muscle weakness (78%). The median number of doses to the development of IM3OS was one. The average creatine kinase level was 9645 IU/L. Cardiac arrhythmias occurred in 67% of patients, and 18% had depressed ejection fraction. Initial treatment consisted of immunosuppression with high-dose steroids and supportive therapies. 60% of the patients died in hospital due to acute complications. Conclusion. IM3OS can be associated with significant mortality and morbidity. Prospective studies are needed to understand the optimal approach to diagnose and manage these patients and to develop biomarkers to predict the occurrence and severity of this rare but serious condition. The Oncologist ;9999:• •
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