Tomsitz Dirk, Grabmaier Ulrich, Spiro Judith, Nicolai Leo, French Lars E, Massberg Steffen, Heinzerling Lucie
Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany.
Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.
Eur J Cancer. 2025 Feb 5;216:115186. doi: 10.1016/j.ejca.2024.115186. Epub 2024 Dec 15.
Immune checkpoint inhibitor (ICI)-induced Myocarditis (irMyocarditis) is a rare adverse event with a high mortality rate of 40-50 % and which is mostly not diagnosed until clinical symptoms emerge.
This study aims to screen patients for irMyocarditis using high-sensitivity cardiac troponin-T (hs-TnT) before and regularly during therapy with ICI.
A cohort of 280 cancer patients were prospectively screened for levels of hs-TnT at baseline and prior to every ICI infusion. In case of elevation of hs-TnT, patients were referred for further work-up.
In total, 196 patients exhibited a baseline hs-TnT ≤ 14 ng/l (99th percentile concentration for general population; group A) and 84 patients a hs-TnT > 14 ng/l at baseline (group B). An increase of hs-TnT during ICI-treatment was observed in 56 out of 196 (27.6 %) and 56 out of 84 patients (66.7 %) in group A and B. Cardiovascular assessment was performed in 11.2 % and 27.4 % of patients, respectively, and 4.1 % and 9.5 % of patients were diagnosed with irMyocarditis and treated with corticosteroids. No fatalities occurred in any of the 16 irMyocarditis patients. Defining a threshold with the highest sensitivity and maximum specificity in receiver-operating characteristics curves, identified a limit of 22 ng/l (group A) and 60 ng/l (group B) hs-TnT, associated with a sensitivity of 100 % in both and a specificity of 91.0 % and 89.6 %, respectively, to detect irMyocarditis.
Screening of hs-TnT can identify irMyocarditis early and lead to reduction of MACE and mortality risk through interruption of ICI-treatment and prompt therapy with corticosteroids.
免疫检查点抑制剂（ICI）诱导的心肌炎（ir心肌炎）是一种罕见的不良事件，死亡率高达40%-50%，且大多在临床症状出现后才被诊断出来。
本研究旨在在ICI治疗前及治疗期间定期使用高敏心肌肌钙蛋白T（hs-TnT）对患者进行ir心肌炎筛查。
前瞻性地对280名癌症患者在基线时以及每次ICI输注前进行hs-TnT水平筛查。若hs-TnT升高，患者将接受进一步检查。
共有196名患者基线时hs-TnT≤14 ng/l（一般人群第99百分位数浓度；A组），84名患者基线时hs-TnT>14 ng/l（B组）。A组196名患者中有56名（27.6%）、B组84名患者中有56名（66.7%）在ICI治疗期间出现hs-TnT升高。分别对11.2%和27.4%的患者进行了心血管评估，4.1%和9.5%的患者被诊断为ir心肌炎并接受了皮质类固醇治疗。16名ir心肌炎患者均未发生死亡。通过在受试者工作特征曲线中确定具有最高灵敏度和最大特异性的阈值，确定hs-TnT的限值为22 ng/l（A组）和60 ng/l（B组），检测ir心肌炎的灵敏度均为100%，特异性分别为91.0%和89.6%。
筛查hs-TnT可早期识别ir心肌炎，并通过中断ICI治疗和及时使用皮质类固醇治疗降低主要不良心血管事件（MACE）和死亡风险。
