How should immune checkpoint inhibitor myocarditis be treated?

Area of Science:

• Cardio-oncology
• Immunology
• Oncology

Background:

• Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but can cause immune-related adverse events.
• Immune checkpoint inhibitor-related myocarditis (ICIrM) is a severe complication with high mortality.
• ICIrM presents heterogeneously, necessitating individualized management strategies.

Purpose of the Study:

• To provide a framework for the individualized management of immune checkpoint inhibitor-related myocarditis (ICIrM) in adults.
• To integrate current guidelines, literature, and clinical experience for ICIrM diagnosis and treatment.
• To highlight the diagnostic and therapeutic challenges posed by ICIrM.

Main Methods:

• Review of current cardio-oncology guidelines and literature on ICIrM.
• Analysis of diagnostic tools including ECG, echocardiography, cardiac MRI, and endomyocardial biopsy.
• Discussion of therapeutic approaches, including corticosteroids and adjunctive immunomodulators like abatacept.
• Case-based illustration of ICIrM management.

Main Results:

• ICIrM diagnosis relies on a combination of clinical presentation, cardiac biomarkers (troponin T/I), and advanced imaging (echocardiography with strain, cardiac MRI).
• Endomyocardial biopsy provides definitive diagnosis and prognostic information.
• High-dose corticosteroids are the primary therapy, reducing adverse cardiovascular events.
• Steroid-refractory cases may benefit from immunomodulators, with abatacept under investigation.

Conclusions:

• ICIrM is a complex condition requiring a personalized diagnostic and therapeutic approach.
• Early detection through serial monitoring and advanced imaging is key.
• Corticosteroids form the basis of treatment, with adjunctive therapies for refractory cases.
• Further research and prospective trials are essential to optimize ICIrM management and patient outcomes.