Department of Medicine, Division of Cardiology, Washington University School of Medicine, Missouri, MO, USA.
Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
Expert Opin Drug Saf. 2023 Jul-Dec;22(10):909-919. doi: 10.1080/14740338.2023.2254218. Epub 2023 Sep 4.
Myocarditis associated with immune checkpoint inhibitors presents with an often-severe clinical phenotype with arrhythmias and concurrent myositis. This condition tends to occur early after treatment onset and is associated with a high fatality rate. Diagnosis may be challenging, and treatment algorithms are still evolving.
This review will provide an overview of immune checkpoint inhibitor mechanism of action and how it relates to myocarditis pathophysiology, diagnostic algorithms and potential pitfalls, and emerging treatment approaches published until May 2023. We will focus on the state of the field and potential new directions in research and patient care. We will also provide consensus-based diagnostic and therapeutic algorithms endorsed by major societies.
The field needs more evidence-based approaches to risk stratification so that therapy can be tailored toward less cardiotoxic alternatives in high-risk patients. For diagnostic and therapeutic approaches, data from animal models are unlikely to provide conclusive evidence given the complexity of the human immune system. We strongly invite practitioners in the field to contribute every case to the ongoing multicenter registries.
免疫检查点抑制剂相关心肌炎表现为常伴有心律失常和同时发生的肌炎的严重临床表型。这种情况往往在治疗开始后早期发生，且死亡率较高。诊断可能具有挑战性，治疗方案仍在不断发展。
本篇综述将概述免疫检查点抑制剂的作用机制及其与心肌炎病理生理学的关系、诊断算法及潜在陷阱、以及截至 2023 年 5 月发表的新兴治疗方法。我们将重点关注该领域的现状以及研究和患者护理方面的潜在新方向。我们还将提供主要学会认可的基于共识的诊断和治疗算法。
该领域需要更多基于循证的风险分层方法，以便能够针对高危患者选择心脏毒性较小的替代疗法。对于诊断和治疗方法，鉴于人类免疫系统的复杂性，来自动物模型的数据不太可能提供确凿的证据。我们强烈邀请该领域的从业者将每个病例纳入正在进行的多中心登记处。
