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Area of Science:

  • Oncology
  • Immunology
  • Neurology

Background:

  • Immune checkpoint inhibitors (ICIs) are crucial cancer therapies.
  • ICI-induced myositis is a rare but serious adverse event.
  • The ICI myositis triad syndrome (myositis, myocarditis, myasthenia gravis) is particularly severe.

Purpose of the Study:

  • To characterize clinical features of ICI myositis.
  • To determine all-cause mortality in patients with ICI myositis.
  • To compare outcomes between ICI triad syndrome and isolated ICI myositis.

Main Methods:

  • National retrospective cohort study of US Veterans treated with ICIs (June 2011-February 2022).
  • Cases identified by elevated creatinine kinase (CK) and/or 'myositis' in clinical notes.
  • Chart review classified patients into ICI triad syndrome or isolated ICI myositis.

Main Results:

  • 68 (0.2%) of 29,296 ICI-treated Veterans had ICI myositis (23 triad, 45 isolated).
  • ICI triad syndrome had median survival of 2.5 months vs. 20.4 months for isolated myositis.
  • Six-month mortality was 60.0% for triad syndrome vs. 30.2% for isolated myositis.

Conclusions:

  • ICI triad syndrome is linked to higher mortality and shorter survival in the first six months post-ICI therapy.
  • Isolated ICI myositis shows similar mortality to ICI-treated patients without myositis.
  • Early identification and management of ICI myositis are critical.