Liu Xiaohang, Wu Wei, Fang Ligang, Liu Yingxian, Chen Wei
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Front Immunol. 2022 Jul 1;13:922782. doi: 10.3389/fimmu.2022.922782. eCollection 2022.
With anti-PD-1 antibodies serving as a representative drug, immune checkpoint inhibitors (ICIs) have become the main drugs used to treat many advanced malignant tumors. However, immune-related adverse events (irAEs), which might involve multiple organ disorders, should not be ignored. ICI-induced myocarditis is an uncommon but life-threatening irAE. Glucocorticoids are the first choice of treatment for patients with ICI-induced myocarditis, but high proportions of steroid-refractory and steroid-resistant cases persist. According to present guidelines, tumor necrosis factor alpha (TNF-α) inhibitors are recommended for patients who fail to respond to steroid therapy and suffer from severe cardiac toxicity, although evidence-based studies are lacking. On the other hand, TNF-α inhibitors are contraindicated in patients with moderate-to-severe heart failure. This review summarizes real-world data from TNF-α inhibitors and other biologic agents for ICI-induced myocarditis to provide more evidence of the efficacy and safety of TNF-α inhibitors and other biologic agents.
以抗程序性死亡蛋白1（PD-1）抗体为代表药物的免疫检查点抑制剂（ICIs）已成为治疗多种晚期恶性肿瘤的主要药物。然而，可能累及多器官功能障碍的免疫相关不良事件（irAEs）不容忽视。ICI诱导的心肌炎是一种罕见但危及生命的irAE。糖皮质激素是ICI诱导心肌炎患者的首选治疗药物，但仍有很大比例的患者出现激素抵抗和难治的情况。根据目前的指南，对于对激素治疗无反应且有严重心脏毒性的患者，推荐使用肿瘤坏死因子α（TNF-α）抑制剂，尽管缺乏循证医学研究。另一方面，中重度心力衰竭患者禁用TNF-α抑制剂。本综述总结了TNF-α抑制剂和其他生物制剂治疗ICI诱导心肌炎的真实世界数据，以提供更多关于TNF-α抑制剂和其他生物制剂疗效和安全性的证据。
