Immune Checkpoint Inhibitors-Associated Myocarditis: Diagnosis, Treatment and Current Status on Rechallenge

Area of Science:

• Cardiology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) targeting CTLA-4, PD-1, and PD-L1 are effective cancer treatments.
• However, ICIs can cause immune-related adverse events (irAEs), including potentially life-threatening cardiac complications like myocarditis.

Purpose of the Study:

• To review cardiovascular complications of ICI therapy, focusing on myocarditis.
• To discuss the challenges in diagnosing and managing ICI-induced myocarditis.
• To evaluate the risks and benefits of immunotherapy rechallenge after cardiac events.

Main Methods:

• Review of existing literature on ICI-related cardiovascular adverse events.
• Analysis of diagnostic tools for ICI-induced myocarditis (biomarkers, ECG, echocardiography, CMR, EMB).
• Examination of treatment strategies, including corticosteroids and second-line immunosuppressants.

Main Results:

• ICI-induced myocarditis, though rare, can be severe with high mortality (38-46%).
• High-dose corticosteroids are the primary treatment, reducing major adverse cardiac events (MACE).
• Therapy rechallenge post-myocarditis carries a risk of recurrence and complications.

Conclusions:

• Management of ICI-induced myocarditis requires prompt diagnosis and treatment with corticosteroids.
• Rechallenging immunotherapy after myocarditis necessitates a multidisciplinary approach and careful risk-benefit assessment.
• Further research is needed to optimize management and guide rechallenge decisions in cancer patients.