Survival After Fulminant Myocarditis Induced by Immune-Checkpoint Inhibitors

Arangalage, Dimitri; Delyon, Julie; Lermuzeaux, Mathilde; Ekpe, Kenneth; Éderhy, Stéphane; Pagès, Cécile; Lebbe, Célèste

doi:10.7326/l17-0396

Cited by 68 publications

(60 citation statements)

References 4 publications

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“…The first specific report of myocarditis during treatment with a PD‐1/PD‐L1 inhibitor was published in 2014 [27], and a number of cases of ICI‐associated myocarditis have been described since . In an early analysis of more than 20,000 patients treated with ICIs, either alone or in combination, the incidence of myocarditis was 0.09%; the incidence of fatal myocarditis in this sample was 0.03% .…”

Section: Current Knowledgementioning

confidence: 75%

“…Based on published accounts and ∼150 cases reviewed at the workshop, the clinical presentation of ICI‐associated myocarditis may be quite variable. Manifestations range from nonspecific symptoms that may be erroneously attributed to underlying disease (e.g., fatigue, chest pain, dyspnea) to acute arrhythmias, conduction disorders, clinical heart failure, and sudden death.…”

Section: Current Knowledgementioning

confidence: 99%

“…Myocarditis has recently emerged as an uncommon adverse reaction in patients administered ICIs, as noted in case reports , clinical trials , safety databases , and registries . Due to the low incidence of ICI‐associated myocarditis, data on presentation, diagnosis, treatment, and outcomes are limited .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Myocarditis Associated with Immune Checkpoint Inhibitors: An Expert Consensus on Data Gaps and a Call to Action

et al. 2018

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Immune checkpoint inhibitors are a class of drugs that trigger the immune system to recognize and fight cancer cells; however, related immune‐related adverse events are a challenge. This commentary describes a workshop convened by Project Data Sphere to determine best approaches in the treatment of myocarditis, with the goal of minimizing the risk of this adverse reaction in patients with cancer who are treated with immune checkpoint inhibitors.

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Section: Current Knowledgementioning

confidence: 75%

Section: Current Knowledgementioning

confidence: 99%

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Myocarditis Associated with Immune Checkpoint Inhibitors: An Expert Consensus on Data Gaps and a Call to Action

et al. 2018

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“…Systemic steroids are recommended for initial therapy, and 1 g per day of intravenous therapy should be considered if hemodynamic impairments are present (104). In steroid-refractory myocarditis, mycophenolate mofetil or tacrolimus should be considered (35,112). Recently, antithymocyte globulin, abatacept (CTLA-4 agonist), and alemtuzumab (anti-CD52 Ab) have been used for the treatment of steroid-refractory myocarditis (113,114).…”

Section: Treatment Strategiesmentioning

confidence: 99%

Clinical Characteristics and Treatment of Immune-Related Adverse Events of Immune Checkpoint Inhibitors

2020

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Immune checkpoint inhibitors (ICIs) have been changing the paradigm of cancer treatment. However, immune-related adverse effects (irAEs) have also increased with the exponential increase in the use of ICIs. ICIs can break up the immunologic homeostasis and reduce T-cell tolerance. Therefore, inhibition of immune checkpoint can lead to the activation of autoreactive T-cells, resulting in various irAEs similar to autoimmune diseases. Gastrointestinal toxicity, endocrine toxicity, and dermatologic toxicity are common side effects. Neurotoxicity, cardiotoxicity, and pulmonary toxicity are relatively rare but can be fatal. ICI-related gastrointestinal toxicity, dermatologic toxicity, and hypophysitis are more common with anti-CTLA-4 agents. ICI-related pulmonary toxicity, thyroid dysfunction, and myasthenia gravis are more common with PD-1/PD-L1 inhibitors. Treatment with systemic steroids is the principal strategy against irAEs. The use of immune-modulatory agents should be considered in case of no response to the steroid therapy. Treatment under the supervision of multidisciplinary specialists is also essential, because the symptoms and treatments of irAEs could involve many organs. Thus, this review focuses on the mechanism, clinical presentation, incidence, and treatment of various irAEs.

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“…Proper guidance and prevention are two essential steps in the management of immunotherapies-related cardiotoxicity. The management of severe or fulminant myocarditis includes supportive care, such as inotropic therapy, mechanical circulatory support (or extracorporeal membrane oxygenation) [ 83 , 84 ], as well as 12-lead ECG is recommended. This investigation can detect a decline in the R-wave amplitude which is suggestive of pericardial effusion and reduced myocardial mass.…”

Section: Type III Cardiomyopathiesmentioning

confidence: 99%

Cardiomyopathies and Arrhythmias Induced by Cancer Therapies

et al. 2020

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Cardiology and oncology are two fields dedicated to the study of various types of oncological and cardiac diseases, but when they collide, a new specialty is born, i.e., cardio-oncology. Continuous research on cancer therapy has brought into the clinic novel therapeutics that have significantly improved patient survival. However, these therapies have also been associated with adverse effects that can impede the proper management of oncological patients through the necessity of drug discontinuation due to life-threatening or long-term morbidity risks. Cardiovascular toxicity from oncological therapies is the main issue that needs to be solved. Proper knowledge, interpretation, and management of new drugs are key elements for developing the best therapeutic strategies for oncological patients. Upon continuous investigations, the profile of cardiotoxicity events has been enlarged with the inclusion of myocarditis upon administration of immune checkpoint inhibitors and cardiac dysfunction in the context of cytokine release syndrome with chimeric antigen receptor T cell therapy. Affinity enhanced and chimeric antigen receptor T cells have both been associated with hypotension, arrhythmia, and left ventricular dysfunction, typically in the setting of cytokine release syndrome. Therefore, the cardiologist must adhere to the progressing field of cancer therapy and become familiar with the adverse effects of novel drugs, and not only the ones of standard care, such as anthracycline, trastuzumab, and radiation therapy. The present review provides essential information summarized from the latest studies from cardiology, oncology, and hematology to bring together the three specialties and offers proper management options for oncological patients.

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Survival After Fulminant Myocarditis Induced by Immune-Checkpoint Inhibitors

Cited by 68 publications

References 4 publications

Myocarditis Associated with Immune Checkpoint Inhibitors: An Expert Consensus on Data Gaps and a Call to Action

Myocarditis Associated with Immune Checkpoint Inhibitors: An Expert Consensus on Data Gaps and a Call to Action

Clinical Characteristics and Treatment of Immune-Related Adverse Events of Immune Checkpoint Inhibitors

Cardiomyopathies and Arrhythmias Induced by Cancer Therapies

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