Immune Checkpoint Inhibitor-Associated Myocarditis: A Literature Review
Rohail Gul1, Muhammad Shehryar2, Anber Mahboob3
1Internal Medicine, Shifa Tameer-E-Millat University Shifa College of Medicine, Islamabad, PAK.
Cureus
|February 26, 2024
Summary
Immune checkpoint inhibitors (ICI) treat cancer but can cause myocarditis, a serious heart condition. Management often involves steroids, and rechallenge decisions require expert consultation due to limited data.
Area of Science:
- Oncology
- Immunology
- Cardiology
Background:
- Immune checkpoint inhibitors (ICI) are increasingly used in oncology for cancer treatment.
- ICI therapy activates the immune system to eliminate cancer cells but can cause immune-related adverse events (irAEs).
- Myocarditis is a potentially fatal irAE associated with ICI therapy.
Purpose of the Study:
- To conduct a narrative review on myocarditis related to immune checkpoint inhibitor (ICI) use.
- To explore the mechanisms, management, and rechallenge strategies for ICI-induced myocarditis.
Main Methods:
- A narrative review of studies.
- Searches conducted in PubMed, Cochrane, and American Society of Clinical Oncology (ASCO) databases.
- Focus on original publications concerning adverse effects of ICI use, specifically myocarditis.
Main Results:
- Cancer immunotherapy with ICI is associated with numerous cases of myocarditis.
- The primary proposed mechanism for myocarditis is immune system cross-reaction, potentially via molecular mimicry.
- Management is primarily based on case reports and series, often starting with steroids; rechallenge data is limited.
Conclusions:
- Despite the risk of myocarditis, the benefits of ICI monotherapies often outweigh the risks.
- Decisions regarding ICI rechallenge after myocarditis require individualized assessment by multidisciplinary teams.
- There is a critical need for more data and prospective studies on ICI-induced myocarditis and rechallenge safety.
Keywords:
checkpoint inhibitor therapyimmune therapy mediated myocarditisimmune-checkpoint inhibitor adverse effectsmultiple myeloma treatmentreviewMore Related Videos
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