Key result
Immune checkpoint inhibitors are associated with a rare (0.02% to 1.14% incidence) but highly fatal (up to 50% mortality) risk of myocarditis, necessitating early diagnosis and corticosteroid therapy.
Why the study?
Immune checkpoint inhibitors treat many cancers but cause systemic effects including myocarditis, prompting a need to review mechanisms, epidemiology, diagnostic criteria, and management.
ICI-associated myocarditis is a rare but highly fatal complication of cancer immunotherapy that requires high clinical suspicion, immediate cessation of the offending agent, and prompt initiation of high-dose corticosteroids.
Warrants vigilance for ICI myocarditis in treated patients; leaves open optimal diagnostic and therapeutic protocols pending prospective data.
Importance: Immune checkpoint inhibitors (ICIs) are a class of immunotherapies that have significant clinical efficacy in treating many cancer types, but they are also associated with systemic effects, including myocarditis. Objective: This review describes potential mechanisms underlying ICI-associated myocarditis; data on epidemiology, including possible risk factors; diagnostic criteria for ICI-associated myocarditis; and recommendations for managing ICI-associated myocarditis. Review: This paper is a narrative literature review that summarizes existing literature to increase awareness of ICI-associated cardiotoxicities, including myocarditis. Findings: Reported cardiovascular adverse events include myocarditis, cardiomyopathy, arrhythmias, pericarditis, vasculitis, atherosclerotic cardiovascular events, Takotsubo syndrome, and venous thromboembolism. Myocarditis is associated with the highest risk of morbidity and mortality. Conclusions: With increasing use of ICIs, there is an urgent need for greater awareness and understanding of ICI-associated myocarditis. Clinicians need to recognize the diagnostic criteria and develop current treatment recommendations for ICI-associated myocarditis given the condition’s variable clinical presentation and potential fulminant course.
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Onderko et al. (2022) conducted a review in Immune checkpoint inhibitor-associated myocarditis. Immune Checkpoint Inhibitors was evaluated. Immune checkpoint inhibitors are associated with a rare (0.02% to 1.14% incidence) but highly fatal (up to 50% mortality) risk of myocarditis, necessitating early diagnosis and corticosteroid therapy.
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