Immune Checkpoint Inhibitor-Associated Myocarditis: Risk, Diagnosis, and Clinical Impact.

Area of Science:

• Oncology
• Cardiology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) have transformed cancer treatment but can cause immune-related adverse events (irAEs).
• ICI-associated myocarditis (ICI-M) is a severe, potentially fatal irAE with high mortality rates (27-50%).

Purpose of the Study:

• To review the pathogenesis, epidemiology, clinical presentation, diagnosis, and management of ICI-induced myocarditis.
• To highlight emerging biomarkers and novel immunosuppressive therapies for ICI-M.

Main Methods:

• Narrative review of existing literature on ICI-M.
• Summary of pathological findings, diagnostic approaches, and treatment strategies.
• Discussion of emerging diagnostic and therapeutic modalities.

Main Results:

• ICI-M often presents within 65 days of treatment, particularly with combination ICI therapy.
• Pathology shows myocyte necrosis and T-cell infiltration, frequently co-occurring with myositis.
• Management involves ICI cessation, high-dose corticosteroids, with second-line options including MMF, IVIG, abatacept, and ruxolitinib for refractory cases.

Conclusions:

• ICI-M is a rare but life-threatening cardiac complication requiring high clinical suspicion and prompt diagnosis.
• Effective management necessitates an aggressive, multidisciplinary approach to balance treatment toxicity and oncologic outcomes.
• Emerging biomarkers and advanced techniques offer potential for earlier detection and risk stratification.