Todo Maki, Gatate Yodo, Nakano Shintaro, Kaneko Go, Hagiwara Masayuki, Takahashi Takayuki, Umezawa Yuta, Ueda Genji, Ishikawa Shiho, Makino Yoshinori, Oyama Masafumi, Shirotake Suguru
Department of Pharmacy, Saitama Medical University Saitama International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan.
Department of Cardiology, Saitama Medical University Saitama International Medical Center, Saitama, Japan.
Cancer Immunol Immunother. 2025 Feb 4;74(3):97. doi: 10.1007/s00262-025-03945-0.
Combination therapy with nivolumab and ipilimumab for advanced renal cell carcinoma (RCC) may cause immune-related myocarditis; however, its incidence in this cancer type and regimen remains unknown. At our institution, we measure biomarkers, such as high-sensitivity Troponin (hsTn), and perform electrocardiograms (ECGs) and echocardiography before and every month after the initiation of this therapy, and the findings obtained and patients' symptoms are continuously monitored by physicians and pharmacists. A retrospective survey was conducted on physiological and biochemical test findings and immune-related adverse events in patients with advanced RCC who received combination therapy with nivolumab and ipilimumab between October 1, 2018 and December 31, 2023. Patients suspected of having myocarditis consulted with cardiologists. Myocarditis due to this therapy was detected in 5 of the 86 patients (5.8%) assessed using the European Society of Cardiology 2022 guidelines. There were no fatal symptoms or death due to myocarditis. The median time to the onset of myocarditis was 25 days (21-86 days). The early detection of myocarditis caused by this therapy requires the monitoring of changes by periodically measuring hsTn and other cardiac markers and performing ECGs and echocardiography from the early stages of administration through to the end of treatment. In addition to checking symptoms, if these abnormalities are detected and myocarditis is suspected, prompt collaboration with cardiologists is recommended. Our management strategy of care by a onco-cardiology team may contribute to the early diagnosis and treatment of myocarditis.
纳武单抗和伊匹单抗联合治疗晚期肾细胞癌（RCC）可能会引起免疫相关性心肌炎；然而，其在这种癌症类型及治疗方案中的发生率尚不清楚。在我们机构，我们会在开始这种治疗前及治疗开始后的每个月测量生物标志物，如高敏肌钙蛋白（hsTn），并进行心电图（ECG）和超声心动图检查，医生和药剂师会持续监测所获得的检查结果及患者症状。我们对2018年10月1日至2023年12月31日期间接受纳武单抗和伊匹单抗联合治疗的晚期RCC患者的生理和生化检查结果及免疫相关不良事件进行了回顾性调查。疑似患有心肌炎的患者会咨询心脏病专家。根据欧洲心脏病学会2022年指南评估，86例患者中有5例（5.8%）检测出因该治疗导致的心肌炎。没有因心肌炎出现致命症状或死亡情况。心肌炎发病的中位时间为25天（21 - 86天）。要早期发现这种治疗引起的心肌炎，需要从给药早期到治疗结束定期测量hsTn和其他心脏标志物、进行心电图和超声心动图检查，以监测变化情况。除了检查症状外，如果检测到这些异常并怀疑患有心肌炎，建议及时与心脏病专家协作。我们由肿瘤心脏病学团队进行护理管理的策略可能有助于心肌炎的早期诊断和治疗。
