Diagnosis of immune checkpoint inhibitor-associated myocarditis: A systematic review

Pradhan, Richeek; Nautiyal, Amit; Singh, Sonal

doi:10.1016/j.ijcard.2019.07.025

Cited by 39 publications

(58 citation statements)

References 40 publications

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“…Troponin is elevated in over 94% cases of myocarditis and a third will have electrocardiographic changes. 121 Early involvement of cardiology is recommended and selected patients may require cardiac catheterisation or cardiac MRI. ICIs should be permanently discontinued in the event of an adverse cardiac event of any grade.…”

Section: General Managementmentioning

confidence: 99%

Diagnosis and management of toxicities of immune checkpoint inhibitors in hepatocellular carcinoma

Sangro

Chan

Meyer

et al. 2020

Journal of Hepatology

185

179

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Immune checkpoint inhibitors (ICIs) have reshaped cancer therapy. ICIs enhance T cell activation through various mechanisms and may help reverse the exhausted phenotype of tumour-infiltrating lymphocytes. However, disrupting the key role that checkpoint molecules play in immune homeostasis may result in autoimmune complications. A broad range of immune-related adverse events (irAEs) involve almost every organ but mostly affect the skin, digestive system, lung, endocrine glands, nervous system, kidney, blood cells, and musculoskeletal system. They are usually manageable but can be lifethreatening. The incidence of irAEs is not very different in patients with hepatocellular carcinoma (HCC) compared to other tumour types, although there is a trend towards a higher incidence of hepatic irAEs. HCC usually develops on a background of cirrhosis with associated systemic manifestations. Extrahepatic organ dysfunction in cirrhosis may cause signs and symptoms that overlap with irAEs or increase their severity. Available guidelines for the management of irAEs have not specifically considered the assessment of toxicities in the context of patients with liver cancer and cirrhosis. This review addresses the toxicity profile of ICIs in patients with HCC, focusing on the challenges that the underlying liver disease poses to their diagnosis and management. Challenges include late recognition, inadequate work-up and delayed treatment, overdiagnosis and inappropriate interruption of ICIs, complications caused by immunosuppressive therapy, and increased cost. A specific algorithm for the management of hepatic irAEs is provided.

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Section: General Managementmentioning

confidence: 99%

Diagnosis and management of toxicities of immune checkpoint inhibitors in hepatocellular carcinoma

Sangro

Chan

Meyer

et al. 2020

Journal of Hepatology

185

179

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“…Although rare, immune checkpoint inhibitor (ICI)-related myocarditis can be life threatening with a mortality rate up to 50% [1,2]. ICI-related myocarditis differs from classical acute myocarditis (which is generally caused by a post-viral immune response) in terms of both clinical presentations and outcomes [3,4]. Patients with ICI-related myocarditis are typically older than patients with non-ICI-related forms of myocarditis (64 years versus 34 years), have other chronic comorbidities in addition to their cancer, and show a higher mortality rate [5].…”

Section: Introductionmentioning

confidence: 99%

Pre-Existing Cardiovascular Conditions as Clinical Predictors of Myocarditis Reporting with Immune Checkpoint Inhibitors: A VigiBase Study

Noseda

Ruinelli

Gaag

et al. 2020

Cancers

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Although rare, immune checkpoint inhibitor (ICI)-related myocarditis can be life-threatening, even fatal. In view of increased ICI prescription, identification of clinical risk factors for ICI-related myocarditis is of primary importance. This study aimed to assess whether pre-existing cardiovascular (CV) patient conditions are associated with the reporting of ICI-related myocarditis in VigiBase, the WHO global database of suspected adverse drug reactions (ADRs). In a (retrospective) matched case-control study, 108 cases of ICI-related myocarditis and 108 controls of ICI-related ADRs other than myocarditis were selected from VigiBase. Drugs labeled as treatment for CV conditions (used as a proxy for concomitant CV risk factors and/or CV diseases) were found to be associated more strongly with the reporting of ICI-related myocarditis than with other ICI-related ADRs (McNemar’s chi-square test of marginal homogeneity: p = 0.026, Cramer’s coefficient of effect size: Φ = 0.214). No significant association was found between pre-existing diabetes and ICI-related myocarditis reporting (McNemar’s test of marginal homogeneity: p = 0.752). These findings offer an invitation for future prospective pharmacoepidemiological studies to assess the causal relationship between pre-existing CV conditions and myocarditis onset in a cohort of cancer patients followed during ICI treatment.

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“…subclinical myocardial dysfunction or pericarditis) it may be possible to restart immunotherapy with close surveillance for recurrence. The close cooperation between oncologist and cardiologist is crucial for appropriate decision [76][77][78][79].…”

Section: Skin Toxicitymentioning

confidence: 99%

“…Of concern, around 50% cases are fatal. Myocarditis may occur with acute manifestation as acute heart failure with cardiogenic shock, multiorgan failure, pulmonary oedema (mimicking pneumonitis), new event of left ventricle impairment, malignant ventricular arrhythmia or advanced conduction disease[78]. ICIs associated cardiotoxic effects can extend beyond myocarditis; however the first approach is to exclude myocarditis; if confirmed it is crucial to urgently follow myocarditis management protocol.Cardiotoxicity is also manifested as arrhythmias included atrial fibrillation, atrioventricular conduction diseases, pericarditis with or without pericardial effusion[76;79].Possible complication is myocardial infarction related to coronary vasculitis or vasospasm.…”

mentioning

confidence: 99%

Immunotherapy of solid tumors: how safely treat the patients

Domagała‐Kulawik

Leszek

Owczarek

et al. 2020

Polish Archives of Internal Medicine

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Immunotherapy with immune checkpoint inhibitors (ICIs) was shown to improve survival of patients with solid tumors like: melanoma, renal carcinoma, non-small cell lung cancer, cutaneous carcinomas or head and neck carcinoma. However, a special type of ICIs toxicity is observed, namely non-infectious inflammation of different organs connected with autoimmunity known as immune related adverse events (irAEs). This non-infectious inflammation may affect different organs and systems as endocrine organs, the gastrointestinal tract, heart, skin and the nervous system. The lungs are also often involved and this condition is referred to as checkpoint inhibitor pneumonitis (CIP). ICIs toxicity is graded from 1 to 5 depending on the clinical course, the 5 grade being a fatal complication. Corticosteroids are the treatment of choice, generally with good efficacy. In some difficult cases, escalation of immunosuppression is required. The knowledge on irAEs should be promoted among clinicians of all specialties, nurses, patients and their families. The aim of this review is to present the wide spectrum of irAEs: clinical signs and symptoms, differential diagnosis, diagnostic procedures and treatment. The data are supported by our own clinical observations.

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Diagnosis of immune checkpoint inhibitor-associated myocarditis: A systematic review

Cited by 39 publications

References 40 publications

Diagnosis and management of toxicities of immune checkpoint inhibitors in hepatocellular carcinoma

Diagnosis and management of toxicities of immune checkpoint inhibitors in hepatocellular carcinoma

Pre-Existing Cardiovascular Conditions as Clinical Predictors of Myocarditis Reporting with Immune Checkpoint Inhibitors: A VigiBase Study

Immunotherapy of solid tumors: how safely treat the patients

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