Key result
Anti-PD1 therapy linked to ~60% lower risk of ICI-related myocarditis in lung cancer.
Why the study?
The clinical characteristics of immune checkpoint inhibitor-related myocarditis in lung cancer remained uncertain.
What are the incidence, risk factors, and prognostic implications of ICI-related myocarditis in patients with lung cancer?
Case-Control (n=1,004)
No
What are the incidence, risk factors, and prognostic implications of ICI-related myocarditis in patients with lung cancer?
ICI-related myocarditis occurs in 6.6% of lung cancer patients treated with immunotherapy, mostly presenting as 'possible' myocarditis with mild prognostic impact, while anti-PD1 therapy and older age appear to be protective factors.
Answers are grounded in this paper and cite their sources.
May aid myocarditis risk assessment during lung cancer immunotherapy; hypothesis-generating and requires prospective validation before guiding therapy.
BACKGROUND: The clinical characteristics of immune checkpoint inhibitors (ICIs)-related myocarditis in lung cancer remains uncertain. The purpose of this study was to evaluate the incidence, clinical characteristics, risk factors, and prognosis of myocarditis in lung cancer patients treated with ICIs. Therefore, this study would enhance the understanding of immune related myocarditis in lung cancer population. METHODS: A total of 1004 patients were analyzed, among those who developed elevated serum creatine kinase isoenzyme, MB form (CK-MB) and/or high-sensitivity troponin I (hs-cTnI) with electrocardiographic or clinical symptoms after immunotherapy were enrolled in the myocarditis group. The same number of patients who had received immunotherapy but didn't develop myocarditis was randomly selected as the control group. Clinicopathologic features, risk factors, and prognostic factors were evaluated in this study. RESULTS: 66 patients (6.6%) developed ICIs-related myocarditis. In these patients, there were 60 case of possible myocarditis (90.9%), 5 probable myocarditis (7.6%), and 1 definite myocarditis (1.5%). The median time to the occurrence of myocarditis was 3.8 months. The median progression-free survival (PFS) for NSCLC and SCLC patients were 24.4 months and 13.0 months, while the median overall survival (OS) for NSCLC and SCLC patients were 43.3 months and 44.6 months. The grade of myocarditis (OR: 5.79; 95%CI: 1.14-29.41, P = 0.034), immunotherapy cycle (OR: 0.38; 95% CI: 0.16-0.92, P = 0.032), and combination of immune-related adverse events (irAEs) (OR: 3.63; 95% CI: 1.55-8.48, P = 0.003) were the influencing factors of PFS in NSCLC patients. In SCLC patients, the immunotherapy cycle was the influential factor for PFS (OR: 0.16; 95%CI: 0.04-0.61, P = 0.007) and OS (OS: 0.12; 95% CI: 0.03-0.48, P = 0.002). Anti-PD1 therapy (OR: 0.4, 95% CI: 0.13-0.97, P = 0.043) and age (OR: 0.36, 95% CI: 0.16-0.84, P = 0.018) might be the protective factors of myocarditis patients compared with the control group. CONCLUSIONS: The presentations of ICIs-related myocarditis in lung cancer are mainly possible myocarditis and probable myocarditis, which have a mild impact on the prognosis. More cycles of ICI treatment accompany the longer the PFS and OS, as a protective factor. Anti-PD1 therapy and older age may be protective factors for ICI-related myocarditis.
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Cao et al. (2025) conducted a case-control in Lung cancer (n=1,004). Anti-PD1 therapy vs. Other immune checkpoint inhibitors (e.g., Anti-PD-L1) was evaluated on Development of ICI-related myocarditis (OR 0.4, 95% CI 0.13-0.97, p=0.043). Anti-PD1 therapy (OR 0.4) and older age (OR 0.36) were identified as protective factors against the development of immune checkpoint inhibitor-related myocarditis in patients with lung cancer.
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