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Prospective screening for myocarditis in cancer patients treated with immune checkpoint inhibitors

Asuka Furukawa1, Yuichi Tamura1, Hirohisa Taniguchi2

  • 1Department of Cardiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan; Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan.

Journal of Cardiology
|August 11, 2022
PubMed
Abstract

Insights

Immune checkpoint inhibitors (ICIs) can cause myocarditis, a serious side effect. A prospective study found 10.3% of patients developed clinically suspected myocarditis, often mild and manageable with continued ICI therapy.

Area of Science:

  • Cardiology
  • Oncology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are vital cancer treatments but can induce autoimmune adverse effects.
  • Myocarditis is a serious complication of ICI therapy, with limited prospective surveillance data.
  • There is a need for systematic monitoring of ICI-treated patients for potential cardiac events.

Purpose of the Study:

  • To establish a prospective screening protocol for clinically suspected myocarditis in patients receiving ICIs.
  • To determine the incidence and characteristics of ICI-induced myocarditis.
  • To evaluate the clinical course and management strategies for myocarditis during ICI treatment.

Main Methods:

  • A prospective cohort of 126 patients treated with ICIs was enrolled.
  • Patients underwent regular clinical evaluations, including vital signs, biomarkers, ECG, chest X-rays, and echocardiography.
  • Monitoring occurred at baseline and at multiple time points up to 60 days post-ICI initiation.

Main Results:

  • Troponin I elevation occurred in 14.3% of patients, with 10.3% presenting clinically suspected myocarditis.
  • Myocarditis was diagnosed early in ICI treatment (median 44 days) and was generally mild.
  • ICI discontinuation was necessary in only 3.2% of cases, with no fatal outcomes reported.

Conclusions:

  • Prospective screening identified a higher-than-expected frequency of myocarditis in ICI-treated patients.
  • Most cases of ICI-induced myocarditis were mild and allowed for continued treatment under close observation.
  • This study highlights the importance of vigilant cardiac monitoring during ICI therapy.
Keywords:
Cardio-oncologyImmune checkpoint inhibitorImmune-related adverse eventMyocarditis

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