Baclig N V, Ngo C, Yeh A C, Chung S H, Cheng A, Grim J, Graf S A, Yang K C
Department of Medicine, University of Washington, USA.
Division of Cardiology, Department of Medicine, University of Washington, USA.
J Clin Case Rep. 2019 Jan 15;2(1):1-4.
While immune checkpoint inhibitors (ICIs) are improving outcomes for many cancers, they can have severe adverse effects. Though cardiac immune-related adverse effects (irAEs) are rare, they have considerable morbidity and mortality. Prior case studies have demonstrated successful treatment of ICI induced autoimmune myocarditis with a variety of immunosuppressive regimens. This case describes steroid-refractory autoimmune myocarditis after treatment with pembrolizumab. Treatment with equine anti-thymocyte globulin, a regimen previously documented to reverse ICI induced autoimmune myocarditis, temporarily improved clinical status and cardiac biomarkers, however eventually failed to prevent progression to heart failure and cardiovascular death. This case highlights the importance of early stress-dose steroids, identifies troponin as a potential marker of treatment response, and underscores the value of collaboration between oncology and cardiology for optimal management.
虽然免疫检查点抑制剂（ICI）正在改善许多癌症的治疗效果，但它们可能会产生严重的不良反应。尽管心脏免疫相关不良反应（irAE）很少见，但它们具有相当高的发病率和死亡率。先前的病例研究表明，使用多种免疫抑制方案成功治疗了ICI诱导的自身免疫性心肌炎。本病例描述了帕博利珠单抗治疗后出现的类固醇难治性自身免疫性心肌炎。使用马抗胸腺细胞球蛋白进行治疗，这是一种先前记录可逆转ICI诱导的自身免疫性心肌炎的方案，暂时改善了临床状况和心脏生物标志物，但最终未能阻止进展为心力衰竭和心血管死亡。本病例强调了早期应激剂量类固醇的重要性，将肌钙蛋白确定为治疗反应的潜在标志物，并强调了肿瘤学和心脏病学之间合作以实现最佳管理的价值。
