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免疫检查点抑制剂导致的暴发性心肌炎:一例病例报告及可能的治疗启示。

Fulminant myocarditis caused by immune checkpoint inhibitor: a case report and possible treatment inspiration.

机构信息

Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.

出版信息

ESC Heart Fail. 2022 Jun;9(3):2020-2026. doi: 10.1002/ehf2.13912. Epub 2022 Mar 23.

Abstract

Immune checkpoint inhibitors (ICIs) have become a new hope for many patients with advanced cancer by blocking tumour immune evasion. However, with the widespread use of ICIs, immune-related adverse events (irAEs) have also been discovered and reported increasingly. Immune-related myocarditis, the most dangerous one of irAEs, still has high mortality in the context of the current treatment. We report the case of a 60-year-old female with fulminant myocarditis induced by ICIs, which caused her to experience frequent ventricular arrhythmias such as ventricular fibrillation and heart failure. She was successfully treated with current mainstream therapies for immune-related myocarditis and additional treatment of sacubitril-valsartan and dapagliflozin. The intriguing observation that the patient condition recovered relatively rapidly in this case shows a possible treatment inspiration, which may be helpful for treating ICIs-associated myocarditis and improving cancer patients' clinical prognosis.

摘要

免疫检查点抑制剂(ICIs)通过阻断肿瘤免疫逃逸,为许多晚期癌症患者带来了新的希望。然而,随着 ICI 的广泛应用,免疫相关不良事件(irAEs)也被发现并越来越多地报道。免疫相关性心肌炎是 irAEs 中最危险的一种,在目前的治疗情况下仍然有很高的死亡率。我们报告了一例由 ICI 引起的暴发性心肌炎的 60 岁女性病例,该患者频繁出现室性心律失常,如室颤和心力衰竭。她成功地接受了目前用于免疫相关性心肌炎的主流治疗方法,并额外使用了沙库巴曲缬沙坦和达格列净进行治疗。有趣的是,在这种情况下,患者的病情恢复相对较快,这可能为治疗 ICI 相关性心肌炎和改善癌症患者的临床预后提供了一种治疗启示。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6575/9065848/86d349c0d770/EHF2-9-2020-g002.jpg

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