Immune checkpoint inhibitor-associated myocarditis: a systematic analysis of case reports

Article Cardiac & Cardiovascular Systems

ESC 2022 guidelines on cardio-oncology in collaboration with the European Hematology Association (EHA), European Society of Therapeutic Radiology and Oncology (ESTRO) and International Cardio-Oncology Society (IC- OS) developed by the Cardio-Oncology Task Force of the European Society of Cardiology (ESC)

Alexander R. Lyon et al.

GIORNALE ITALIANO DI CARDIOLOGIA (2023)

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Editorial Material Oncology

Myasthenia Gravis and Myocarditis After Administration of Pembrolizumab in a Patient With Metastatic Non-small Cell Lung Cancer and Resected Thymoma

Wanyi Kee et al.

CLINICAL LUNG CANCER (2022)

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Article Cardiac & Cardiovascular Systems

Asymptomatic Myocarditis with Mild Cardiac Marker Elevation Following Nivolumab-Induced Myositis

Akito Shindo et al.

Summary: Although rare, myocarditis following ICI therapy is clinically important due to its high mortality rate. We report a case of ICI-induced myositis and asymptomatic myocarditis with mild cardiac marker elevation, highlighting the importance of detecting concurrent myocarditis in patients with ICI-induced myositis through intensive cardiac assessments.

INTERNATIONAL HEART JOURNAL (2022)

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Article Oncology

Severe immune-related hepatitis and myocarditis caused by PD-1 inhibitors in the treatment of triple-negative breast cancer: a case report

Yiting Yang et al.

Summary: Research has found that the use of immune checkpoint inhibitors (ICIs) in the treatment of triple-negative breast cancer (TNBC) can lead to immune-related adverse events (irAEs). In this case report, a TNBC patient experienced severe hepatitis and myocarditis after receiving chemotherapy combined with PD-1 inhibitors. The patient's condition was successfully managed through timely treatment and recovery.

ANNALS OF TRANSLATIONAL MEDICINE (2022)

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Article Medicine, General & Internal

Case Report: Acute Myocarditis Due to PD-L1 Inhibitor Durvalumab Monotherapy in a Patient With Lung Squamous Cell Carcinoma

Bo Zhou et al.

Summary: This case report presents a rare case of myocarditis after PD-L1 inhibitor therapy. The patient developed myocardial injury after receiving durvalumab monotherapy, but quickly recovered to normal after glucocorticoids treatment.

FRONTIERS IN MEDICINE (2022)

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Article Cardiac & Cardiovascular Systems

Camrelizumab-Related Lethal Arrhythmias and Myasthenic Crisis in a Patient with Metastatic Thymoma

Bo Zhang et al.

Summary: This article reports a case of immune-related adverse events (irAEs) in a patient treated with camrelizumab, leading to the patient's death. It emphasizes the importance of close follow-up after ICI treatment and highlights the multidisciplinary team approach.

CASE REPORTS IN CARDIOLOGY (2022)

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Article Medicine, General & Internal

Ipilimumab- and nivolumab-induced myocarditis in a patient with metastatic cholangiocarcinoma: a case report

Danielle Delombaerde et al.

Summary: A case of early-onset myocarditis in an asymptomatic patient treated with dual checkpoint inhibition is reported. This case highlights the urgent need for early diagnosis and treatment of this severe immune-related adverse event.

JOURNAL OF MEDICAL CASE REPORTS (2022)

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Article Cardiac & Cardiovascular Systems

2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS) Developed by the task force on cardio-oncology of the European Society of Cardiology (ESC)

Alexander R. Lyon et al.

EUROPEAN HEART JOURNAL (2022)

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Article Cardiac & Cardiovascular Systems

Immune checkpoint inhibitor-related myocarditis: an illustrative case series of applying the updated Cardiovascular Magnetic Resonance Lake Louise Criteria

Bernd J. Wintersperger et al.

Summary: ICIs have improved outcomes for many types of cancer, but can also lead to myocarditis. The use of CMR with modified Lake Louise Criteria and relaxometry techniques is effective in diagnosing ICI myocarditis, with non-ischaemic myocardial injury criteria being the most common finding.

EUROPEAN HEART JOURNAL-CASE REPORTS (2022)

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Review Pharmacology & Pharmacy

Clinical Pharmacology and Interplay of Immune Checkpoint Agents: A Yin-Yang Balance

Arthur Geraud et al.

Summary: T cells play a crucial role in immune system balance, and immune checkpoint proteins regulate their function. CTLA-4 agonists are used to treat rheumatologic immune disorders, while CTLA-4, PD-1, and PD-L1 antagonists are approved for multiple cancer types. However, immune checkpoint inhibitors may be associated with immune-related adverse events.

ANNUAL REVIEW OF PHARMACOLOGY AND TOXICOLOGY, VOL 61, 2021 (2021)

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Review Medicine, Research & Experimental

Immune Checkpoint Inhibitors for the Treatment of Cancer: Clinical Impact and Mechanisms of Response and Resistance

Sreya Bagchi et al.

Summary: This article highlights the significance of immune checkpoint inhibitors in cancer immunotherapy and the research findings on the changes in local and systemic immune cells after treatment. It emphasizes the need for understanding the requirements for an effective and safe antitumor immune response following ICI therapy.

ANNUAL REVIEW OF PATHOLOGY: MECHANISMS OF DISEASE, VOL 16, 2021 (2021)

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Article Oncology

A Genetic Mouse Model Recapitulates Immune Checkpoint Inhibitors-Associated Myocarditis and Supports a Mechanism-Based Therapeutic Intervention

Spencer C. Wei et al.

Summary: This study presents a robust preclinical model of ICI-associated myocarditis that recapitulates the clinical syndrome. Using this model, researchers demonstrate that CTLA4 and PD-1 (ICI targets) functionally interact in the development of myocarditis, and intervention with CTLA4-Ig (abatacept) attenuates myocarditis, providing mechanistic rationale and preclinical support for therapeutic clinical studies.

CANCER DISCOVERY (2021)

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Review Medicine, Research & Experimental

Immune checkpoint inhibitor-associated myocarditis: manifestations arms mechanisms

Javid Moslehi et al.

Summary: Immune checkpoint inhibitors have revolutionized the treatment of cancer, but associated toxicities like myocarditis pose challenges that require further research, predictive biomarker identification, and improved diagnostic and treatment strategies.

JOURNAL OF CLINICAL INVESTIGATION (2021)

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Review Oncology

The Next Decade of Immune Checkpoint Therapy

Padmanee Sharma et al.

Summary: Immune checkpoint therapy can provide durable antitumor responses for subsets of cancer patients, but challenges remain in understanding resistance mechanisms, optimizing patient selection, managing immune-related adverse events, and identifying rational therapeutic combinations. A focused approach encompassing clinical and basic research with integration of reverse translational studies is needed to address these challenges and guide the development of novel combination strategies.

CANCER DISCOVERY (2021)

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Article Immunology

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

Li Shen et al.

Summary: Immune checkpoint inhibitor therapy shows promise for late-stage thymic epithelial tumors, but careful monitoring for irAEs is necessary. In this case, dose adjustment led to tumor remission and reduced toxicity, highlighting the importance of individualized treatment approaches.

FRONTIERS IN IMMUNOLOGY (2021)

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Article Cardiac & Cardiovascular Systems

Immune checkpoint inhibitor myocarditis: elucidating the spectrum of disease through endomyocardial biopsy

Nicolas L. Palaskas et al.

Summary: A grading system was developed for ICI myocarditis based on degree of inflammatory infiltrate, with some patients able to continue ICI without immunosuppressive therapy and have good cardiovascular outcomes. Further studies are needed to identify low-risk patients who can safely receive ICI therapy.

EUROPEAN JOURNAL OF HEART FAILURE (2021)

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Review Cardiac & Cardiovascular Systems

Clinical Strategy for the Diagnosis and Treatment of Immune Checkpoint Inhibitor-Associated Myocarditis A Narrative Review

Lorenz H. Lehmann et al.

Summary: ICIs have become an important treatment option for various cancer types, but their use is associated with the risk of myocarditis. The diagnosis of ICI-associated myocarditis can be challenging and relies on a combination of clinical suspicion, cardiac biomarkers, imaging, and endomyocardial biopsy. Combining different types of ICIs may increase the risk of developing myocarditis.

JAMA CARDIOLOGY (2021)

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Article Cardiac & Cardiovascular Systems

Checkpoint inhibitor-induced fulminant myocarditis, complete atrioventricular block and myasthenia gravis-a case report

Antonio Portoles Hernandez et al.

Summary: Immune checkpoint inhibitors have revolutionized cancer therapy, but can lead to serious immune-mediated side effects such as myocarditis, which may progress rapidly to a fatal outcome if not promptly recognized and managed. A high index of suspicion and advanced cardiac imaging techniques are important for early detection and treatment of ICI-induced myocarditis.

CARDIOVASCULAR DIAGNOSIS AND THERAPY (2021)

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Article Cardiac & Cardiovascular Systems

Burden of Cardiomyopathic Genetic Variation in Lethal Pediatric Myocarditis

Amy R. Kontorovich et al.

Summary: The study found that deleterious variants in genes related to cardiomyocyte integrity are more common in children with fatal acute myocarditis in New York City compared to controls matched by genetic ancestry. These variants may confer susceptibility to myocardial inflammation and result in more rapid and severe disease progression.

CIRCULATION-GENOMIC AND PRECISION MEDICINE (2021)

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Article Cardiac & Cardiovascular Systems

A case report of immune checkpoint inhibitor-related steroid-refractory myocarditis and myasthenia gravis-like myositis treated with abatacept and mycophenolate mofetil

Mette Syberg Jespersen et al.

Summary: Immune checkpoint inhibitor (ICI)-related myocarditis is a rare but potentially fatal immune-related adverse event. Glucocorticoids are the mainstay of treatment for ICI-related myocarditis, with supplementary immunosuppressive agents recommended for steroid-refractory cases like the one presented in this case study.

EUROPEAN HEART JOURNAL-CASE REPORTS (2021)

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Article Medicine, General & Internal

Nivolumab-Induced Myasthenia Gravis Concomitant With Myocarditis, Myositis, and Hepatitis

Sawyer J. Bawek et al.

Summary: A Caucasian male patient developed myasthenia gravis, myocarditis, and myositis following treatment for melanoma with nivolumab. Despite negative antibody tests, clinical symptoms supported a diagnosis of myasthenia gravis. Treatment with corticosteroids, IVIG, and pyridostigmine resulted in improvement in diplopia.

CUREUS JOURNAL OF MEDICAL SCIENCE (2021)

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Editorial Material Biotechnology & Applied Microbiology

Trends in clinical development for PD-1/PD-L1 inhibitors

Jia Xin Yu et al.

NATURE REVIEWS DRUG DISCOVERY (2020)

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Review Oncology

A review of cancer immunotherapy toxicity

Lucy Boyce Kennedy et al.

CA-A CANCER JOURNAL FOR CLINICIANS (2020)

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Article Cardiac & Cardiovascular Systems

Recognition and Initial Management of Fulminant Myocarditis A Scientific Statement From the American Heart Association

Robb D. Kociol et al.

CIRCULATION (2020)

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Article Cardiac & Cardiovascular Systems

Acute fatal myocarditis after a single dose of anti-PD-1 immunotherapy, autopsy findings: a case report

Tanner Hardy et al.

CARDIOVASCULAR PATHOLOGY (2020)

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Article Medicine, General & Internal

Immune-related adverse events of checkpoint inhibitors

Manuel Ramos-Casals et al.

NATURE REVIEWS DISEASE PRIMERS (2020)

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Article Oncology

Nivolumab resulting in persistently elevated troponin levels despite clinical remission of myocarditis and myositis in a patient with malignant pleural mesothelioma: case report

Gabrielle Lie et al.

TRANSLATIONAL LUNG CANCER RESEARCH (2020)

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Letter Cardiac & Cardiovascular Systems

Major Adverse Cardiovascular Events and the Timing and Dose of Corticosteroids in Immune Checkpoint Inhibitor-Associated Myocarditis

Lili Zhang et al.

CIRCULATION (2020)

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Review Immunology

Immune checkpoint inhibitor-induced myositis, the earliest and most lethal complication among rheumatic and musculoskeletal toxicities

Yves Allenbach et al.

AUTOIMMUNITY REVIEWS (2020)

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Article Oncology

Severe combined cardiac and neuromuscular toxicity from immune checkpoint blockade: an institutional case series

Puja Arora et al.

CARDIO-ONCOLOGY (2020)

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Article Medicine, General & Internal

A Case of Acute Heart Failure Following Immunotherapy for Metastatic Lung Cancer

Ammar Al-Obaidi et al.

CUREUS JOURNAL OF MEDICAL SCIENCE (2020)

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Article Cardiac & Cardiovascular Systems

Myocarditis in the Setting of Cancer Therapeutics Proposed Case Definitions for Emerging Clinical Syndromes in Cardio-Oncology

Marc P. Bonaca et al.

CIRCULATION (2019)

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Article Oncology

Fatal myocarditis and rhabdomyositis in a patient with stage IV melanoma treated with combined ipilimumab and nivolumab

S. D. Saibil et al.

CURRENT ONCOLOGY (2019)

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Letter Medicine, General & Internal

Alemtuzumab for Immune-Related Myocarditis Due to PD-1 Therapy

Khashayar Esfahani et al.

NEW ENGLAND JOURNAL OF MEDICINE (2019)

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Letter Medicine, General & Internal

Abatacept for Severe Immune Checkpoint Inhibitor-Associated Myocarditis

Joe-Elie Salem et al.

NEW ENGLAND JOURNAL OF MEDICINE (2019)

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Article Oncology

Successful therapy for autoimmune myocarditis with pembrolizumab treatment for nasopharyngeal carcinoma

Qingqing Wang et al.

ANNALS OF TRANSLATIONAL MEDICINE (2019)

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Article Cardiac & Cardiovascular Systems

Myocarditis with checkpoint inhibitor immunotherapy: case report of late gadolinium enhancement on cardiac magnetic resonance with pathology correlate

Cesia Gallegos et al.

EUROPEAN HEART JOURNAL-CASE REPORTS (2019)

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Editorial Material Hematology

Anti-PD1 associated fulminant myocarditis after a single pembrolizumab dose: the role of occult pre-existing autoimmunity

Nicolas Martinez-Calle et al.

HAEMATOLOGICA (2018)

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Article Oncology

Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline

Julie R. Brahmer et al.

JOURNAL OF CLINICAL ONCOLOGY (2018)

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Article Cardiac & Cardiovascular Systems

Myocarditis in Patients Treated With Immune Checkpoint Inhibitors

Syed S. Mahmood et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2018)

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Letter Medicine, General & Internal

Increased reporting of fatal immune checkpoint inhibitor-associated myocarditis

Javid J. Moslehi et al.

LANCET (2018)

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Editorial Material Hematology

Anti-PD1 associated fulminant myocarditis after a single pembrolizumab dose: the role of occult pre-existing autoimmunity

Nicolas Martinez-Calle et al.

HAEMATOLOGICA (2018)

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Review Oncology

Fatal Toxic Effects Associated With Immune Checkpoint Inhibitors A Systematic Review and Meta-analysis

Daniel Y. Wang et al.

JAMA ONCOLOGY (2018)

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Article Oncology

Cardiovascular toxicities associated with immune checkpoint inhibitors: an observational, retrospective, pharmacovigilance study

Joe-Elie Salem et al.

LANCET ONCOLOGY (2018)

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Article Obstetrics & Gynecology

Myocarditis with tremelimumab plus durvalumab combination therapy for endometrial cancer: A case report

Syed S. Mahmood et al.

GYNECOLOGIC ONCOLOGY REPORTS (2018)

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Article Cardiac & Cardiovascular Systems

Diagnosis and management of myocardial involvement in systemic immune-mediated diseases: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Disease

Alida L. P. Caforio et al.

EUROPEAN HEART JOURNAL (2017)

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Letter Medicine, General & Internal

Myocarditis with Immune Checkpoint Blockade

Stephane Ederhy et al.

NEW ENGLAND JOURNAL OF MEDICINE (2017)

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Article Oncology

Smoldering myocarditis following immune checkpoint blockade

Timothy G. Norwood et al.

JOURNAL FOR IMMUNOTHERAPY OF CANCER (2017)

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Letter Medicine, General & Internal

Survival After Fulminant Myocarditis Induced by Immune-Checkpoint Inhibitors

Dimitri Arangalage et al.

ANNALS OF INTERNAL MEDICINE (2017)

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Article Medicine, General & Internal

Fulminant Myocarditis with Combination Immune Checkpoint Blockade

Douglas B. dbj Johnson et al.

NEW ENGLAND JOURNAL OF MEDICINE (2016)

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Review Medicine, General & Internal

Cardiovascular Toxic Effects of Targeted Cancer Therapies

Javid J. Moslehi

NEW ENGLAND JOURNAL OF MEDICINE (2016)

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Review Medicine, General & Internal

Rayyan-a web and mobile app for systematic reviews

Mourad Ouzzani et al.

SYSTEMATIC REVIEWS (2016)

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Review Immunology

The heart of the matter: Protection of the myocardium from T cells

Andrew H. Lichtman

JOURNAL OF AUTOIMMUNITY (2013)

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Review Oncology

The blockade of immune checkpoints in cancer immunotherapy

Drew M. Pardoll

NATURE REVIEWS CANCER (2012)

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Article Cardiac & Cardiovascular Systems

Diagnosis of myocarditis - Death of Dallas criteria

KL Baughman

CIRCULATION (2006)

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Immune checkpoint inhibitor-associated myocarditis: a systematic analysis of case reports

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