Immune Checkpoint Inhibitors-Associated Myocarditis: Diagnosis, Treatment and Current Status on Rechallenge
Immune checkpoint molecules like cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death 1 (PD-1) or its ligand, programmed cell death ligand 1 (PD-L1), play a critical role in regulating the immune response, and immune checkpoint inhibitors (ICIs) targeting these checkpoints have shown cli...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/24/7737 |
| _version_ | 1797380543833178112 |
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| author | Federica Frascaro Nicola Bianchi Federico Sanguettoli Federico Marchini Sofia Meossi Luca Zanarelli Elisabetta Tonet Matteo Serenelli Gabriele Guardigli Gianluca Campo Luana Calabrò Rita Pavasini |
| author_facet | Federica Frascaro Nicola Bianchi Federico Sanguettoli Federico Marchini Sofia Meossi Luca Zanarelli Elisabetta Tonet Matteo Serenelli Gabriele Guardigli Gianluca Campo Luana Calabrò Rita Pavasini |
| author_sort | Federica Frascaro |
| collection | DOAJ |
| description | Immune checkpoint molecules like cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death 1 (PD-1) or its ligand, programmed cell death ligand 1 (PD-L1), play a critical role in regulating the immune response, and immune checkpoint inhibitors (ICIs) targeting these checkpoints have shown clinical efficacy in cancer treatment; however, their use is associated with immune-related adverse events (irAEs), including cardiac complications. The prevalence of cardiac irAEs, particularly myocarditis, is relatively low, but they can become a severe and potentially life-threatening condition, usually occurring shortly after initiating ICI treatment; moreover, diagnosing ICI-related myocarditis can be challenging. Diagnostic tools include serum cardiac biomarkers, electrocardiography (ECG), echocardiography, cardiac magnetic resonance (CMR) and endomyocardial biopsy (EMB). The treatment of ICI-induced myocarditis involves high-dose corticosteroids, which have been shown to reduce the risk of major adverse cardiac events (MACE). In refractory cases, second-line immunosuppressive drugs may be considered, although their effectiveness is based on limited data. The mortality rates of ICI-induced myocarditis, particularly in severe cases, are high (38–46%). Therapy rechallenge after myocarditis is associated with a risk of recurrence and severe complications. The decision to rechallenge should be made on a case-by-case basis, involving a multidisciplinary team of cardiologists and oncologists. Further research and guidance are needed to optimize the management of cancer patients who have experienced such complications, evaluating the risks and benefits of therapy rechallenge. The purpose of this review is to summarize the available evidence on cardiovascular complications from ICI therapy, with a particular focus on myocarditis and, specifically, the rechallenge of immunotherapy after a cardiac adverse event. |
| first_indexed | 2024-03-08T20:38:49Z |
| format | Article |
| id | doaj.art-5c97fa0e838b49f1b961141b0a55e0db |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T20:38:49Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-5c97fa0e838b49f1b961141b0a55e0db2023-12-22T14:17:36ZengMDPI AGJournal of Clinical Medicine2077-03832023-12-011224773710.3390/jcm12247737Immune Checkpoint Inhibitors-Associated Myocarditis: Diagnosis, Treatment and Current Status on RechallengeFederica Frascaro0Nicola Bianchi1Federico Sanguettoli2Federico Marchini3Sofia Meossi4Luca Zanarelli5Elisabetta Tonet6Matteo Serenelli7Gabriele Guardigli8Gianluca Campo9Luana Calabrò10Rita Pavasini11UO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, ItalyUO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, ItalyUO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, ItalyUO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, ItalyUO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, ItalyUO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, ItalyUO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, ItalyUO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, ItalyUO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, ItalyUO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, ItalyDipartimento di Medicina Translazionale e per la Romagna, Univerity of Ferrara, 44121 Ferrara, ItalyUO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, ItalyImmune checkpoint molecules like cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death 1 (PD-1) or its ligand, programmed cell death ligand 1 (PD-L1), play a critical role in regulating the immune response, and immune checkpoint inhibitors (ICIs) targeting these checkpoints have shown clinical efficacy in cancer treatment; however, their use is associated with immune-related adverse events (irAEs), including cardiac complications. The prevalence of cardiac irAEs, particularly myocarditis, is relatively low, but they can become a severe and potentially life-threatening condition, usually occurring shortly after initiating ICI treatment; moreover, diagnosing ICI-related myocarditis can be challenging. Diagnostic tools include serum cardiac biomarkers, electrocardiography (ECG), echocardiography, cardiac magnetic resonance (CMR) and endomyocardial biopsy (EMB). The treatment of ICI-induced myocarditis involves high-dose corticosteroids, which have been shown to reduce the risk of major adverse cardiac events (MACE). In refractory cases, second-line immunosuppressive drugs may be considered, although their effectiveness is based on limited data. The mortality rates of ICI-induced myocarditis, particularly in severe cases, are high (38–46%). Therapy rechallenge after myocarditis is associated with a risk of recurrence and severe complications. The decision to rechallenge should be made on a case-by-case basis, involving a multidisciplinary team of cardiologists and oncologists. Further research and guidance are needed to optimize the management of cancer patients who have experienced such complications, evaluating the risks and benefits of therapy rechallenge. The purpose of this review is to summarize the available evidence on cardiovascular complications from ICI therapy, with a particular focus on myocarditis and, specifically, the rechallenge of immunotherapy after a cardiac adverse event.https://www.mdpi.com/2077-0383/12/24/7737immune checkpoint inhibitors related myocarditiscardio oncologyrechallenge |
| spellingShingle | Federica Frascaro Nicola Bianchi Federico Sanguettoli Federico Marchini Sofia Meossi Luca Zanarelli Elisabetta Tonet Matteo Serenelli Gabriele Guardigli Gianluca Campo Luana Calabrò Rita Pavasini Immune Checkpoint Inhibitors-Associated Myocarditis: Diagnosis, Treatment and Current Status on Rechallenge Journal of Clinical Medicine immune checkpoint inhibitors related myocarditis cardio oncology rechallenge |
| title | Immune Checkpoint Inhibitors-Associated Myocarditis: Diagnosis, Treatment and Current Status on Rechallenge |
| title_full | Immune Checkpoint Inhibitors-Associated Myocarditis: Diagnosis, Treatment and Current Status on Rechallenge |
| title_fullStr | Immune Checkpoint Inhibitors-Associated Myocarditis: Diagnosis, Treatment and Current Status on Rechallenge |
| title_full_unstemmed | Immune Checkpoint Inhibitors-Associated Myocarditis: Diagnosis, Treatment and Current Status on Rechallenge |
| title_short | Immune Checkpoint Inhibitors-Associated Myocarditis: Diagnosis, Treatment and Current Status on Rechallenge |
| title_sort | immune checkpoint inhibitors associated myocarditis diagnosis treatment and current status on rechallenge |
| topic | immune checkpoint inhibitors related myocarditis cardio oncology rechallenge |
| url | https://www.mdpi.com/2077-0383/12/24/7737 |
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