Zhou Qihao, Qin Zhiquan, Wu Guoqing, Yan Peiyuan, Wang Qunjiang, Qu Jing, Jiang Jiahong, Ye Da
Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
Front Oncol. 2024 Sep 16;14:1465395. doi: 10.3389/fonc.2024.1465395. eCollection 2024.
Immune checkpoint inhibitors (ICIs) have become a prevalent tool in anti-tumor therapy in recent years. They may cause immune-related adverse events (irAEs) including potentially life-threatening cardiovascular toxicities such as myocarditis.
In this report, we describe a 69-year-old man with recurrent esophageal cancer who developed myocarditis after receiving three cycles of sintilimab combined with nab-paclitaxel. Despite a rising cardiac troponin I (cTnI), he initially reported no discomfort. He was later suspected of having with sintilimab-induced myocarditis. Although treatment with methylprednisolone reduced his cTnI levels, he still experienced significant discomfort. Moreover, he developed pneumonia and septic shock.
In our literature search to identify all reported cases of sintilimab-associated adverse events involving myocarditis, we found 14 patients, including those with esophageal cancer, thymoma, lung cancer, gastric cancer, hepatobiliary carcinoma, and chordoma. The primary treatment for ICI-induced cardiotoxicity is methylprednisolone. However, the long-term or high-dose use of steroids can also induce side effects, which have not been the focus of these case reports. This is the first reported case of asymptomatic immune-mediated myocarditis occurring during the treatment of esophageal cancer with sintilimab. It is also the first to address the side effects of methylprednisolone used in the treatment of sintilimab-related myocarditis. To facilitate an early diagnosis, regular monitoring is required during sintilimab treatment. We should also focus on the prevention and management of adverse effects related to steroid use.
近年来，免疫检查点抑制剂（ICIs）已成为抗肿瘤治疗中的一种常用工具。它们可能会引起免疫相关不良事件（irAEs），包括潜在危及生命的心血管毒性，如心肌炎。
在本报告中，我们描述了一名69岁复发性食管癌男性患者，在接受三个周期的信迪利单抗联合白蛋白紫杉醇治疗后发生了心肌炎。尽管心肌肌钙蛋白I（cTnI）水平升高，但他最初报告无不适。他后来被怀疑患有信迪利单抗诱导的心肌炎。尽管使用甲泼尼龙治疗降低了他的cTnI水平，但他仍感到明显不适。此外，他还发生了肺炎和感染性休克。
在我们检索所有已报道的涉及心肌炎的信迪利单抗相关不良事件病例时，我们发现了14例患者，包括食管癌、胸腺瘤、肺癌、胃癌、肝胆癌和脊索瘤患者。ICI诱导的心脏毒性的主要治疗方法是甲泼尼龙。然而，长期或高剂量使用类固醇也会引发副作用，而这些副作用尚未成为这些病例报告的重点。这是首例报道的在用信迪利单抗治疗食管癌期间发生的无症状免疫介导性心肌炎病例。这也是首例探讨用于治疗信迪利单抗相关心肌炎的甲泼尼龙的副作用的病例。为便于早期诊断，在信迪利单抗治疗期间需要进行定期监测。我们还应关注与类固醇使用相关的不良反应的预防和管理。
