Department of Oncology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clin Res Cardiol. 2021 Jan;110(1):50-60. doi: 10.1007/s00392-020-01648-3. Epub 2020 Apr 15.
Immune checkpoint inhibitors (ICI) have transformed the standard care of cancer treatment. Recent case reports describe ICI-mediated myocarditis with an atypical presentation and fatal potential which lead to permanent interruption of immunotherapy.
To characterize ICI-mediated myocarditis and re-introduction to immunotherapy.
During 2019, 849 patients were treated with ICI at Tel Aviv Sourasky Medical Center for the diagnosis of lung adenocarcinoma, gastric adenocarcinoma, urothelial carcinoma, and hepatocellular carcinoma. Overall, seven (0.8%) patients were diagnosed with ICI-mediated myocarditis, according to the European Society of Cardiology guidelines of myocarditis 2013. We retrospectively evaluated their presentation, severity, and clinical outcomes.
Among the seven patients, only one had a history of cardiac disease. The majority were diagnosed with lung adenocarcinoma and treated with anti-programmed death-1 antibody. All patients were treated with single-agent ICI. Most patients presented with cardiac symptoms, elevated troponin and typical cardiac magnetic resonance; however, only three had reduced ejection fraction. Overall, three patients were chosen for re-introduction with concomitant low dose steroids and weekly troponin follow-up. Two patients diagnosed with grade I and II renewed therapy successfully with no recurrence of symptoms and improvement in disease burden. The one patient diagnosed with grade III developed worsening of cardiac symptoms after the 1st cycle and, therefore, therapy was interrupted permanently.
ICI-mediated myocarditis is potentially fatal and leads to permanent interruption of life-saving cancer therapy. The current data suggest that re-introduction may be considered in low-grade patients; however, a better definition of the diagnosis and grading is needed.
免疫检查点抑制剂（ICI）改变了癌症治疗的标准护理。最近的病例报告描述了具有非典型表现和潜在致命性的 ICI 介导心肌炎，导致免疫治疗永久中断。
描述 ICI 介导的心肌炎和重新引入免疫治疗。
在 2019 年期间，849 名患者在特拉维夫索拉斯基医疗中心接受 ICI 治疗，用于诊断肺腺癌、胃腺癌、尿路上皮癌和肝细胞癌。根据欧洲心脏病学会 2013 年心肌炎指南，共有 7 名（0.8%）患者被诊断为 ICI 介导的心肌炎。我们回顾性评估了他们的表现、严重程度和临床结局。
在这 7 名患者中，只有 1 名有心脏病史。大多数患者被诊断为肺腺癌，并接受了抗程序性死亡 1 抗体治疗。所有患者均接受了单药 ICI 治疗。大多数患者表现为心脏症状、肌钙蛋白升高和典型的心脏磁共振；然而，只有 3 名患者射血分数降低。总体而言，有 3 名患者选择重新引入低剂量类固醇和每周肌钙蛋白随访。2 名被诊断为 I 级和 II 级的患者成功重新开始治疗，没有症状复发且疾病负担改善。1 名被诊断为 III 级的患者在第 1 个周期后出现心脏症状恶化，因此永久中断了治疗。
ICI 介导的心肌炎具有潜在的致命性，导致救命癌症治疗的永久中断。目前的数据表明，在低级别患者中可能需要重新考虑重新引入治疗；然而，需要更好地定义诊断和分级。
