Department of Oncodermatology, Université de Nantes, CHU Nantes, CIC 1413, CRCINA, Nantes, France.
Department of Epidemiology and Biostatistics, CHU Nantes, CRCINA, INSERM 1232, Université de Nantes, Nantes, France.
Eur J Dermatol. 2021 Apr 1;31(2):205-212. doi: 10.1684/ejd.2021.4009.
Immune checkpoint inhibitors have improved the management of metastatic melanoma, however, we have witnessed an emergence of adverse cardiac events such as myocarditis.
We first aimed to assess the prevalence of adverse cardiac events in patients treated with anti-PD-1 for metastatic melanoma. Our second objective was to determine the role of troponin monitoring in the diagnosis of these events.
MATERIALS & METHODS: We retrospectively analysed the prevalence of patients treated with anti-PD-1 in a real-life setting based on a cohort of 183 patients. We then performed a prospective cohort, in which clinical and biological profiles of patients were collected, along with monthly monitoring of troponin levels.
The prevalence of adverse cardiac events in the retrospective cohort was 2.2%, with three cases of myocarditis and one of myocardial infarction. In the prospective cohort, 14/52 patients had an abnormal baseline troponin T level. All patients had a history of cardiac or vascular complaints. Six patients showed an increase in troponin T level during follow-up, in two patients associated with clinical symptoms.
Adverse cardiac events with immunotherapy are both frequent and life-threatening. Troponin T may be of interest to detect early adverse cardiac events before any clinical sign, however, the data supporting this remain to be confirmed.
免疫检查点抑制剂改善了转移性黑色素瘤的治疗效果，但同时也出现了心肌炎等不良心脏事件。
我们首先旨在评估抗 PD-1 治疗转移性黑色素瘤患者不良心脏事件的发生率。我们的第二个目标是确定肌钙蛋白监测在这些事件诊断中的作用。
我们回顾性分析了基于 183 例患者队列的真实环境中接受抗 PD-1 治疗的患者的不良心脏事件发生率。然后，我们进行了前瞻性队列研究，收集了患者的临床和生物学特征，并每月监测肌钙蛋白水平。
回顾性队列中不良心脏事件的发生率为 2.2%，包括 3 例心肌炎和 1 例心肌梗死。在前瞻性队列中，52 例患者中有 14 例基线肌钙蛋白 T 水平异常。所有患者均有心脏或血管疾病的病史。在随访期间，有 6 例患者的肌钙蛋白 T 水平升高，其中 2 例伴有临床症状。
免疫治疗相关的不良心脏事件既常见又危及生命。肌钙蛋白 T 可能有助于在任何临床症状出现之前检测早期不良心脏事件，但支持这一点的数据仍需确认。
