Myocarditis as an immune-related adverse event following treatment with ipilimumab and nivolumab combination therapy for metastatic renal cell carcinoma: a case report

Miyauchi, Yoshimasa; Naito, Hirohito; Tsunemori, Hiroyuki; Tani, Ryosuke; Hasui, Yusuke; Miyake, Yuichi; Minamino, Tetsuo; Ishikawa, Ryou; Kushida, Yoshio; Haba, Reiji; Sugimoto, Mikio

doi:10.1186/s13256-021-03097-6

Cited by 11 publications

(5 citation statements)

References 10 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, it appears that a combination of multiple drugs can promote overall survival, suggesting that when the effects of methylprednisolone treatment alone are unsatisfactory, outcomes are improved by adding other immunosuppressive agents. Furthermore, six patients were treated initially with prednisone, followed by other immunosuppressive agents; three (50%) were alive after immunosuppressive therapy ( Nasr et al, 2018 ; Yamaguchi et al, 2018 ; Agrawal et al, 2019 ) and two patients were alive after receiving prednisone alone ( Guo et al, 2020 ; Miyauchi et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Prednisone combined with another immunosuppressive agent usually provides benefit in patients with cancer ( Nasr et al, 2018 ; Yamaguchi et al, 2018 ; Agrawal et al, 2019 ; Guo et al, 2020 ; von Itzstein et al, 2020 ; Luo et al, 2021 ), although some patients do not survive ( Konstantina et al, 2019 ). Furthermore, one case report showed that prednisone alone improved cardiac function in a patient with ICI-induced myocarditis ( Miyauchi et al, 2021 ).…”

Section: Clinical Evaluations Of Therapy Against Ici-induced Cardioto...mentioning

confidence: 99%

See 1 more Smart Citation

Drug therapy for myocarditis induced by immune checkpoint inhibitors

2023

Front. Pharmacol.

View full text Add to dashboard Cite

Immune checkpoint inhibitors (ICIs), including cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death 1 (PD-1), and its ligand 1 (PD-L1), have improved the survival in multiple types of cancers; however, ICIs may cause cardiovascular toxicity. Although rare, ICI-mediated cardiotoxicity is an extremely serious complication with a relatively high mortality. In this review, we discuss the underlying mechanism and clinical manifestations of cardiovascular toxicity induced by ICIs. According to previous studies, multiple signaling pathways are involved in myocarditis induced by ICIs. Further, we summarize the clinical trials of drugs for the treatment of ICI-associated myocarditis. Although these drugs have shown the beneficial effects of alleviating cardiac function and reducing mortality rates, their efficacy is not optimal. Finally, we discuss the therapeutic potential of some novel compounds as well as the underlying mechanisms of their action.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Clinical Evaluations Of Therapy Against Ici-induced Cardioto...mentioning

confidence: 99%

Drug therapy for myocarditis induced by immune checkpoint inhibitors

2023

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…Grade 3 or higher adverse effects are seen in 7-13% of total patients treated with PD-1 inhibitors [21]. Serious side effects associated with PD-1 inhibitors include myocarditis, pneumonitis, autoimmune hepatitis, encephalitis, and hypothyroidism [1,[21][22][23][24][25]. PD-L1 assay, though FDA approved, has reduced sensitivity and specificity compared with other diagnostic assays and has limited utility in predicting the clinical benefits of ICI [26].…”

Section: Discussionmentioning

confidence: 99%

Complete response to nivolumab in Kirsten rat sarcoma virus oncogene KRAS-G12C mutant metastatic lung adenocarcinoma: a case report

et al. 2022

View full text Add to dashboard Cite

Background The advent of immunotherapies has ushered in a new era in the treatment of non-small cell lung carcinoma. Although immunotherapies are associated with improved clinical outcomes, studies report a median overall survival of 11 months with progression-free survival of 2.5 months with the use of nivolumab for pretreated metastatic non-small cell lung cancer. Herein, we describe a case of advanced non-small cell lung carcinoma that has shown exceptional response to immunotherapy, with the patient being in complete response for the past 6 years since commencement of nivolumab. Case presentation We report the case of a 58-year-old female Caucasian, an ex-smoker with 40-pack-year history of smoking, who presented with cough and chest pain and was subsequently diagnosed with metastatic pulmonary adenocarcinoma. The tumor was positive for Kirsten rat sarcoma virus oncogene KRAS-G12C mutation and had high programmed death-1 ligand expression. She was commenced on first-line chemotherapy with carboplatin and gemcitabine with disease response, then continued on maintenance pemetrexed. She was then commenced on immunotherapy with nivolumab, with complete response for a total of 6 years. She does not report any adverse events. Currently, she shows no evidence of recurrence of non-small cell lung carcinoma. Conclusion The exceptional response to immunotherapy seen in this case may be explained by the presence of Kirsten rat sarcoma virus oncogene mutation, which is associated with enhanced clinical response to programmed death-1 ligand inhibitors. This report emphasizes the urgent need for further studies evaluating the role of Kirsten rat sarcoma virus oncogene mutation in determining the clinical efficacy of immunotherapies. This would enable us to make effective evidence-based clinical interventions in the treatment of non-small cell lung carcinoma.

show abstract

“…One such case was reported after a 70year-old Japanese female with advanced hepatocellular cancer was initiated on atezolizumab plus bevacizumab therapy [8]. Another case was reported when a 71-year-old Asian man with metastatic renal cell cancer on ipilimumab and nivolumab combination therapy presented with symptoms of rapidly worsening cardiogenic shock [9]. Similarly, it has also been reported in a 51-year-old woman with triplenegative breast cancer with a history of modified radical mastectomy after she received chemotherapy combined with PD-1 inhibitors [10].…”

Section: Adverse Eventsmentioning

confidence: 99%

Immune Checkpoint Inhibitor-Associated Myocarditis: A Literature Review

Gul,

Shehryar,

Mahboob

et al. 2024

Cureus

View full text Add to dashboard Cite

Recently in the field of oncology, immune checkpoint inhibitors (ICI) are being increasingly utilized both in clinical trials and in clinical practice. It is a form of biological therapy that targets tumors by activating the immune system, which in turn eliminates proliferating cancer cells. These have numerous immune-related adverse events (irAEs), one of which is myocarditis, which has high rates of mortality. This article was a narrative review of myocarditis related to ICI use.Studies from the PubMed, Cochrane, and American Society of Clinical Oncology (ASCO) databases were used in writing this review. The databases were searched for original publications for adverse effects related to ICI use and myocarditis specifically. There are numerous published instances of cancer immunotherapy causing myocarditis. ICI therapy has numerous benefits, as it upregulates the immune system to target cancer cells, utilizing the body's own defense mechanisms to target proliferating cells. Myocarditis is a serious side effect, however. Therefore, on balance, these monotherapies are worth using. While this literature review primarily identifies cross-reaction as the main mechanism of myocarditis, there are other possible mechanisms. One proposed mechanism involves a shared antigen between the myocardial tissue and the tumor. This mechanism is called molecular mimicry, where the monoclonal antibody attacks both the myocardial tissue and the tumor cell.Management of ICI-induced myocarditis has not been studied by randomized controlled trials or prospective studies, but based on previous case reports and case series it is mostly treated with steroids initially. An ICI rechallenge after temporary discontinuation appears conceivable in many cases, especially given its therapeutic effects, but only limited data are available on the safety of a rechallenge after an irAE. The lack of RCTs regarding rechallenge with an ICI after irAE, more so specifically about myocarditis, along with the overall results and the complexity involved in such cases once again emphasize the need to make decisions on an individual basis by a multidisciplinary expert working group. At the same time, the focus should also be on publishing more data as the need will grow along with the indications for ICI therapies.

show abstract

Myocarditis as an immune-related adverse event following treatment with ipilimumab and nivolumab combination therapy for metastatic renal cell carcinoma: a case report

Cited by 11 publications

References 10 publications

Drug therapy for myocarditis induced by immune checkpoint inhibitors

Drug therapy for myocarditis induced by immune checkpoint inhibitors

Complete response to nivolumab in Kirsten rat sarcoma virus oncogene KRAS-G12C mutant metastatic lung adenocarcinoma: a case report

Immune Checkpoint Inhibitor-Associated Myocarditis: A Literature Review

Contact Info

Product

Resources

About