Department of Radiotherapy, The First Affiliated Hospital of Nanjing Medical College, Nanjing 210029, China; Cancer Centre of People's Liberation Army, Jinling Hospital, Nanjing 210002, China.
Department of Radiotherapy, The First Affiliated Hospital of Nanjing Medical College, Nanjing 210029, China.
Chin Clin Oncol. 2020 Apr;9(2):16. doi: 10.21037/cco.2020.03.08. Epub 2020 Apr 7.
Immune checkpoint inhibitor (ICI)-associated myocarditis is a rare and potentially fatal immune-related adverse event (irAE). The study aimed to observe the occurrence of myocarditis caused by ICIs.
The clinical manifestations, diagnosis, and treatment of immune myocarditis were explored through retrospective analysis of the detailed data of typical ICI-associated myocarditis from our center and a literature review.
From January 1, 2018, to December 31, 2019, a total of 283 patients were treated with PD-1 or PD-L1 monoclonal antibodies (McAbs) alone or combination therapy at our center. There were 3 cases of ICI-associated myocarditis, of which the incidence rate was 1.06% (3/283); among these cases, 2 were treated with nivolumab alone, and 1 was treated with camrelizumab combined with gemcitabine. One case died on day 56 because of heart and respiratory failure, and the other died on day 34 because of tumor progression. The third case recovered after treatment. The typical clinical manifestations are palpitations, dyspnea, and fatigue. One patient had no clear symptoms. Electrocardiograms (ECG) showed grade 3 of atrioventricular block and frequent ventricular premature contraction in one case, and frequent ventricular and atrial premature contraction in the other case. Most of the cardiac biomarkers decreased or returned to normal after glucocorticoid treatment.
ICI-associated myocarditis is a rare adverse event but has a high mortality rate. Early diagnosis of myocarditis and prompt glucocorticoid therapy may be helpful to improve the prognosis.
免疫检查点抑制剂（ICI）相关心肌炎是一种罕见且潜在致命的免疫相关不良事件（irAE）。本研究旨在观察 ICI 引起的心肌炎的发生情况。
通过回顾性分析本中心典型的 ICI 相关心肌炎的详细资料，并结合文献复习，探讨免疫性心肌炎的临床表现、诊断和治疗。
2018 年 1 月 1 日至 2019 年 12 月 31 日，本中心共 283 例患者单独或联合使用 PD-1 或 PD-L1 单克隆抗体（McAb）治疗，共发生 3 例 ICI 相关心肌炎，发生率为 1.06%（3/283）；其中 2 例为纳武利尤单抗单药治疗，1 例为卡瑞利珠单抗联合吉西他滨治疗。1 例患者因心、呼吸衰竭于第 56 天死亡，1 例患者因肿瘤进展于第 34 天死亡，第 3 例患者经治疗后恢复。典型临床表现为心悸、呼吸困难和乏力。1 例患者无明确症状。心电图（ECG）显示 1 例患者为三度房室传导阻滞和频发室性早搏，另 1 例患者为频发室性和房性早搏。糖皮质激素治疗后多数心脏生物标志物降低或恢复正常。
ICI 相关心肌炎是一种罕见的不良事件，但死亡率较高。早期诊断心肌炎并及时给予糖皮质激素治疗可能有助于改善预后。
