Department of Pharmacy, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan, China.
Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Immunol. 2023 Oct 9;14:1275254. doi: 10.3389/fimmu.2023.1275254. eCollection 2023.
Immune checkpoint inhibitors (ICIs) therapy can be complicated by their potential cardiovascular toxicities, including myocarditis. Nowadays, no prospective trials have focused on ICI-associated myocarditis optimized management. Available evidence only come from case reports or series. A systematic case reports analysis was conducted to collect and evaluate emerging evidence of ICI-associated myocarditis to provide more information to clinicians.
We performed a literature search for eligible case reports or series published between January 2018 and May 2023 using the PubMed database. Then, we extracted interesting information via table form. Finally, this study included 113 publications on 106 patients with ICI-associated myocarditis.
Myocarditis was found to be a highly life-threatening disease, with 53.8% of cases. Over half of cases were life-threatening (G4, 23.6%) or severe (G3, 35.8%) and required glucocorticoids. Higher rates of improvement were associated with the best response to ICI for complete response/partial response (72.7% vs. 53.9%), glucocorticoid administration (30% vs. 22%), and discontinuation of ICI (58.8% vs. 32.1%). Consequently, ICI-associated G3-G4 myocarditis should be treated with a combination of discontinuation of ICIs, high-dose glucocorticoids, other drugs, chemical drugs, plasma exchange, and life support. For moderate G1 or G2 cases, discontinuation of ICIs and regular-dose glucocorticoids should be considered.
Once full recovery or improvement was achieved; glucocorticoids can be administered at low doses or stopped. Notably, re-challenge with ICIs appears feasible after resolution or meaningful improvement of myocarditis.
免疫检查点抑制剂 (ICI) 治疗可能会因其潜在的心血管毒性而变得复杂，包括心肌炎。目前，尚无前瞻性试验专门针对 ICI 相关心肌炎的优化管理进行研究。现有的证据仅来自病例报告或系列研究。本研究通过系统的病例报告分析，收集并评估了与 ICI 相关心肌炎的新证据，为临床医生提供更多信息。
我们使用 PubMed 数据库检索了 2018 年 1 月至 2023 年 5 月期间发表的符合条件的病例报告或系列研究。然后，我们通过表格形式提取了有趣的信息。最终，这项研究纳入了 113 篇关于 106 例 ICI 相关心肌炎的文献。
心肌炎是一种具有高度生命威胁性的疾病，占 53.8%。超过一半的病例为危及生命（G4，23.6%）或严重（G3，35.8%），需要使用糖皮质激素。对 ICI 反应最佳的病例，如完全缓解/部分缓解（72.7%比 53.9%）、糖皮质激素治疗（30%比 22%）和 ICI 停药（58.8%比 32.1%）的改善率更高。因此，对于 G3-G4 级 ICI 相关心肌炎，应采用 ICI 停药、大剂量糖皮质激素、其他药物、化学药物、血浆置换和生命支持的联合治疗。对于中重度 G1 或 G2 病例，应考虑 ICI 停药和常规剂量糖皮质激素治疗。
一旦获得完全恢复或改善，可给予低剂量糖皮质激素或停药。值得注意的是，在心肌炎得到缓解或明显改善后，重新使用 ICI 似乎是可行的。
