Immune Checkpoint Inhibitor-Associated Myocarditis.

Area of Science:

• Cardiology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) revolutionized cancer treatment by enhancing anti-tumor immune responses.
• However, ICIs can disrupt immune homeostasis, leading to immune-related adverse events affecting various organs.
• Cardiotoxicity, specifically myocarditis, is a rare but severe complication of ICI therapy.

Observation:

• ICI-associated myocarditis presents with diverse clinical manifestations, often overlapping with other cardiovascular conditions, complicating diagnosis.
• The exact incidence is likely underestimated due to diagnostic challenges and lack of awareness.
• Risk factors are not well-defined, but combination immunotherapies may increase prevalence.

Findings:

• Myocarditis typically occurs early in ICI treatment, often with elevated troponin levels and potentially preserved ejection fraction.
• The clinical course can be fulminant, ranging from cardiogenic shock to sudden death.
• High-dose corticosteroids are the mainstay of current management, though optimal strategies remain unclear.

Implications:

• There is an urgent need for clear guidelines on surveillance, diagnosis, and management of ICI-associated myocarditis.
• Further research is required to identify at-risk patients, elucidate pathophysiology, and optimize treatment.
• Understanding and addressing ICI-related cardiotoxicity is crucial for safe and effective cancer immunotherapy.