Mahmood Syed S, Chen Carol L, Shapnik Natalie, Krishnan Udhay, Singh Harsimran S, Makker Vicky
Cardiology Division, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, United States.
Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Gynecol Oncol Rep. 2018 Jun 1;25:74-77. doi: 10.1016/j.gore.2018.05.014. eCollection 2018 Aug.
Fulminant myocarditis has been reported in patients treated with immune checkpoint inhibitors. We present the first described case of acute immune-mediated myocarditis and myositis associated with durvalumab plus tremelimumab combination therapy. The patient was undergoing treatment for advanced endometrial cancer.
A 75-year-old Caucasian female presented with difficulty ambulating due to neck protraction, imbalance, and increased shortness of breath with exertion 3 weeks after her first durvalumab and tremelimumab administration for advanced endometrial cancer. While the patient's initial laboratory data showed an acute transaminitis and elevated creatine phosphokinase (CPK), consistent with myositis, she developed complete heart block and ventricular dysfunction, with elevated troponins. Endomyocardial biopsy confirmed a diagnosis of immune-mediated myocarditis. She was treated with high-dose steroids and mycophenolate mofetil, which led to eventual native conduction and left ventricular ejection fraction recovery. Upon discharge, she was titrated off of steroids over 8 weeks and her mycophenolate was subsequently stopped. A follow-up computed tomography scan revealed progression of metastatic disease. The patient remains alive using supplemental oxygen 3 months after admission.
Durvalumab plus tremelimumab combination therapy can lead to fulminant immune-mediated myocarditis. This patient's myocarditis was amenable to treatment with high-dose intravenous steroids and mycophenolate.
免疫检查点抑制剂治疗的患者中曾有暴发性心肌炎的报道。我们报告首例与度伐利尤单抗联合曲美木单抗联合治疗相关的急性免疫介导性心肌炎和肌炎病例。该患者正在接受晚期子宫内膜癌的治疗。
一名75岁的白人女性，在首次使用度伐利尤单抗和曲美木单抗治疗晚期子宫内膜癌3周后，因颈部前伸、失衡以及运动时呼吸急促加重而出现行走困难。患者最初的实验室检查数据显示急性转氨酶升高和肌酸磷酸激酶（CPK）升高，符合肌炎表现，随后她出现了完全性心脏传导阻滞和心室功能障碍，肌钙蛋白升高。心内膜活检确诊为免疫介导性心肌炎。她接受了大剂量类固醇和霉酚酸酯治疗，最终窦性传导和左心室射血分数得以恢复。出院时，她在8周内逐渐停用类固醇，随后停用霉酚酸酯。后续计算机断层扫描显示转移性疾病进展。入院3个月后，患者通过吸氧维持生命。
度伐利尤单抗联合曲美木单抗联合治疗可导致暴发性免疫介导性心肌炎。该患者的心肌炎可用大剂量静脉注射类固醇和霉酚酸酯治疗。
