Key result
ICIs cause high-mortality myocarditis in ~0.5% of patients early in the treatment course.
Why the study?
Patients with cancer face multiple potential etiological factors for myocarditis, including conventional chemotherapy, radiotherapy, infections, and immunotherapy.
Immune checkpoint inhibitors can cause potentially fatal myocarditis, requiring baseline ECG and troponin testing, and prompt diagnosis with imaging and biomarkers if symptoms arise.
Answers are grounded in this paper and cite their sources.
Warrants baseline ECG and troponin before ICI initiation with prompt imaging for symptoms; reinforces cardio-oncology protocols for early myocarditis detection.
Patients with cancer have multiple etiological factors for the development of myocarditis. Classical or conventional chemotherapy, radiotherapy and, more recently, immunotherapy have been described as possible etiological causes of myocarditis. In addition, patients with cancer are immunosuppressed and more susceptible to bacterial and viral infections that can cause myocarditis. This review discusses the many possible causes of myocarditis in patients with cancer. Special emphasis is placed on myocarditis induced by immune checkpoint inhibitors (ICI). ICI myocarditis usually affects male patients over 50 years of age who are being treated for lung cancer, melanoma or renal cell carcinoma and have multiple comorbidities. Clinical manifestations occur early, with elevated troponin and electrocardiogram changes. The mortality rate is high. Treatment consists of discontinuation of the causative ICI and corticosteroid therapy. Myocarditis caused by cyclophosphamide, anthracyclines, 5-fl uorouracil, cisplatin, carboplatin, proteasome inhibitors, immunomodulators, tyrosine kinase inhibitors, and radiotherapy was also reviewed.
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Razlozhka et al. (2025) conducted a review in Myocarditis related to immune checkpoint inhibitor treatment. Immune checkpoint inhibitors (ICI) was evaluated on Incidence and clinical characteristics of myocarditis induced by immune checkpoint inhibitors (<0.5% incidence). Immune checkpoint inhibitors cause myocarditis in less than 0.5% of patients, typically within 12 weeks of treatment, with a high mortality rate and necessitating discontinuation and corticosteroid therapy.
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