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帕博利珠单抗诱导的心肌炎的临床特征、治疗及预后

Clinical characteristics, treatment and prognosis of pembrolizumab induced myocarditis.

作者信息

Wu Zhaoquan, Sun Wei, Wang Chunjiang

机构信息

College of Pharmacy, Changsha Medical University, No. 1501 Leifeng Avenue, Xiangjiang New District, Changsha, 410219, China.

Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, 410219, Hunan, China.

出版信息

Invest New Drugs. 2025 Aug 13. doi: 10.1007/s10637-025-01575-y.


DOI:10.1007/s10637-025-01575-y
PMID:40802145
Abstract

To explore the regularity and clinical characteristics of pembrolizumab induced myocarditis, and to provide a reference for the diagnosis and treatment of myocarditis. Clinical reports of pembrolizumab induced myocarditis were collected by searching the database as of May 31, 2025. Clinical data were extracted and analyzed statistically. A total of 97 patients were enrolled in the study, with a median age of 70 years (range 25, 89), of which 53(54.6%) were male. The median time for diagnosis of myocarditis was 25 days (range 3, 4050). The common clinical symptoms were dyspnoea (23.7%), shortness of breath (16.5%), and thoracic pain (13.4%). Myositis and/or myasthenia gravis occurred in 43.3% of the patients. These patients with myocarditis may be accompanied by abnormalities in myocardial biomarkers, electrocardiograms, cardiac magnetic resonance and echocardiograms. After the patients discontinued pembrolizumab and received steroid-based immunotherapy, 72.2% of the patients recovered and 26.8% of the patients died. Myocarditis is a rare and fatal immune-related adverse event of pembrolizumab. Cardiac biomarkers, electrocardiograms and echocardiograms should be monitored during the use of Pembrolizumab. Cardiac magnetic resonance or myocardial biopsy can be used to further confirm myocarditis.

摘要

探讨帕博利珠单抗所致心肌炎的发生规律及临床特点,为心肌炎的诊治提供参考。通过检索数据库收集截至2025年5月31日帕博利珠单抗所致心肌炎的临床报道。提取临床资料并进行统计学分析。本研究共纳入97例患者,中位年龄70岁(范围2589岁),其中男性53例(54.6%)。心肌炎诊断的中位时间为25天(范围34050天)。常见临床症状为呼吸困难(23.7%)、气短(16.5%)和胸痛(13.4%)。43.3%的患者发生了肌炎和/或重症肌无力。这些心肌炎患者可能伴有心肌生物标志物、心电图、心脏磁共振和超声心动图异常。患者停用帕博利珠单抗并接受以类固醇为基础的免疫治疗后,72.2%的患者恢复,26.8%的患者死亡。心肌炎是帕博利珠单抗罕见且致命的免疫相关不良事件。使用帕博利珠单抗期间应监测心脏生物标志物、心电图和超声心动图。可采用心脏磁共振或心肌活检进一步确诊心肌炎。

相似文献

[1]
Clinical characteristics, treatment and prognosis of pembrolizumab induced myocarditis.

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本文引用的文献

[1]
Myocarditis Following Pembrolizumab Plus Axitinib, and Belzutifan Plus Lenvatinib for Renal Cell Carcinoma: A Case Report.

Cardiovasc Toxicol. 2024-11

[2]
Pembrolizumab with bevacizumab and cyclophosphamide for the treatment of recurrent ovarian clear cell carcinoma: A case series.

Gynecol Oncol Rep. 2024-4-2

[3]
Immune Checkpoint Inhibitors-Related Myocarditis: A Review of Reported Clinical Cases.

Diagnostics (Basel). 2023-3-25

[4]
A Case of Lung Cancer with Very-Late-Onset Immune Checkpoint Inhibitor-Related Myocarditis.

CJC Open. 2022-3-24

[5]
Management of Immunotherapy-Related Toxicities, Version 1.2022, NCCN Clinical Practice Guidelines in Oncology.

J Natl Compr Canc Netw. 2022-4

[6]
Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update.

J Clin Oncol. 2021-12-20

[7]
Immune Checkpoint Inhibitor-Induced Myocarditis with Myositis/Myasthenia Gravis Overlap Syndrome: A Systematic Review of Cases.

Oncologist. 2021-12

[8]
Immune-Therapy-Related Toxicity Events and Dramatic Remission After a Single Dose of Pembrolizumab Treatment in Metastatic Thymoma: A Case Report.

Front Immunol. 2021

[9]
Delayed immune-related adverse events with anti-PD-1-based immunotherapy in melanoma.

Ann Oncol. 2021-7

[10]
Immune checkpoint inhibitor-associated myocarditis: manifestations and mechanisms.

J Clin Invest. 2021-3-1

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