Department of Cardiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan; Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan.
Department of Cardiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan; Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan.
J Cardiol. 2023 Jan;81(1):63-67. doi: 10.1016/j.jjcc.2022.07.009. Epub 2022 Aug 9.
Immune checkpoint inhibitors (ICIs) improve clinical outcomes in various cancers, but sometimes induce autoimmune adverse effects, including myocarditis, which is the most serious complication. There are many reports on ICI-induced myocarditis; however, only a few prospective surveillance reports exist. Therefore, we developed a prospective screening protocol and performed monitoring clinically suspected myocarditis in every patient treated with ICIs.
We prospectively enrolled 126 consecutive patients treated with ICIs in this cohort. Outcomes of patients were determined and analyzed between April 2017 and May 2020. We evaluated vital signs, biomarkers, electrocardiograms, chest radiographs, and echocardiographs before and at 7 ± 3, 14 ± 3, 21 ± 3, and 60 ± 7 days after ICI initiation.
Eighteen (14.3 %) presented troponin I elevation and 13 of them presented signs of clinically suspected myocarditis (10.3 %). Among the 13 patients, ICI was discontinued in four cases (3.2 %) without fatal events. Myocarditis appeared at an early stage of ICI treatment, regardless of severity (median, 44 days).
We observed the frequency of patients with myocarditis or myocardial damage through a prospective screening program in the real world. Although the frequency was higher than expected, most cases were mild and ICI treatment could be continued under careful observation.
免疫检查点抑制剂（ICI）可改善多种癌症的临床结局，但有时会引发自身免疫不良反应，包括心肌炎，这是最严重的并发症。已有许多关于 ICI 诱导性心肌炎的报告，但仅有少数前瞻性监测报告存在。因此，我们制定了一项前瞻性筛查方案，并对每例接受 ICI 治疗的患者进行临床疑似心肌炎的监测。
我们前瞻性纳入了本队列中 126 例连续接受 ICI 治疗的患者。评估了 2017 年 4 月至 2020 年 5 月期间患者的结局。我们在 ICI 起始前、7±3、14±3、21±3 和 60±7 天评估了生命体征、生物标志物、心电图、胸部 X 线和超声心动图。
18 例（14.3%）出现肌钙蛋白 I 升高，其中 13 例出现临床疑似心肌炎的表现（10.3%）。在这 13 例患者中，4 例（3.2%）停用了 ICI，无致命事件发生。心肌炎在 ICI 治疗的早期阶段出现，无论严重程度如何（中位数为 44 天）。
我们通过一项真实世界中的前瞻性筛查方案观察到了心肌炎或心肌损伤患者的发生频率。尽管频率高于预期，但大多数病例为轻度，且在密切观察下可继续 ICI 治疗。
