Zhang Lili, Jones-O'Connor Maeve, Awadalla Magid, Zlotoff Daniel A, Thavendiranathan Paaladinesh, Groarke John D, Villani Alexandra-Chloe, Lyon Alexander R, Neilan Tomas G
Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Suite 400, 165 Cambridge Street, Boston, MA, 02114, USA.
Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Curr Treat Options Cardiovasc Med. 2019 Jun 8;21(7):32. doi: 10.1007/s11936-019-0731-6.
Immunotherapies, particularly immune checkpoint inhibitors (ICI), are revolutionary cancer therapies being increasingly applied to a broader range of cancers. Our understanding of the mechanism, epidemiology, diagnosis, and treatment of cardiotoxicity related to immunotherapies remains limited. We aim to synthesize the limited current literature on cardiotoxicity of ICIs and to share our opinions on the diagnosis and treatment of this condition.
The incidence of ICI-associated myocarditis ranges from 0.1 to 1%. Patients with ICI-associated myocarditis often have a fulminant course with a case fatality rate of 25-50%. The diagnosis of this condition poses many challenges because independently a normal electrocardiogram, biomarkers, or a preserved left ventricular function do not rule out ICI-associated myocarditis. Endomyocardial biopsy should be pursued when clinical suspicion remains despite normal non-invasive tests. Data on optimal screening and surveillance tools are lacking. Cessation of ICIs, combined with high dose corticosteroids and other immunosuppressant approaches are the cornerstones of the treatment of ICI-associated myocarditis. This condition may recur when patients are re-challenged with these agents and the decision to resume ICIs should be made through a multidisciplinary discussion. Immunotherapies have changed the landscape of cancer treatment. Recognizing and managing cardiotoxicity related to ICIs is of critical importance. Our understanding of ICI-cardiotoxicity has improved, but large information gaps remain for further research. Due to the high case fatality rate, any type of cardiac symptoms or signs in a patient who has recently started an ICI should prompt consideration of ICI-cardiotoxicity.
免疫疗法，尤其是免疫检查点抑制剂（ICI），是具有革命性的癌症治疗方法，正越来越广泛地应用于各类癌症。我们对免疫疗法相关心脏毒性的机制、流行病学、诊断和治疗的了解仍然有限。我们旨在综合当前关于ICI心脏毒性的有限文献，并分享我们对这种情况诊断和治疗的看法。
ICI相关心肌炎的发病率在0.1%至1%之间。ICI相关心肌炎患者通常病情急骤，病死率为25%至50%。这种疾病的诊断面临诸多挑战，因为心电图、生物标志物正常或左心室功能正常并不能排除ICI相关心肌炎。尽管无创检查结果正常，但临床仍怀疑时应进行心内膜心肌活检。目前缺乏关于最佳筛查和监测工具的数据。停用ICI，联合大剂量皮质类固醇和其他免疫抑制方法是治疗ICI相关心肌炎的基石。当患者再次使用这些药物时，这种情况可能会复发，是否恢复使用ICI应通过多学科讨论来决定。免疫疗法改变了癌症治疗的格局。认识和处理与ICI相关的心脏毒性至关重要。我们对ICI心脏毒性的理解有所提高，但仍存在大量信息空白有待进一步研究。由于病死率高，近期开始使用ICI的患者出现任何类型的心脏症状或体征都应考虑ICI心脏毒性。
