Review analysis of reported cases of myocarditis induced by immune checkpoint inhibitors / 中国医师杂志

ABSTRACT

Objective:To explore the clinical characteristics and influencing factors of myocarditis induced by immune checkpoint inhibitors (ICIs).Methods:Using programmed death receptor-1 (PD-1), nivolumab, pembrolizumab, programmed cell death receptor ligand-1 (PD-L1), atezolizumab, durvalumab, avelumab, cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), ipilimumab, tremelimumab as keywords respectively, we combined these words with myocarditis or the corresponding Chinese to search.Results:A total of 49 articles were reported, including 64 patients. Nivolumab was the most reported, followed by pembrolizumab and ipilimumab. The average age was (65.47±13.24)years, mainly elderly patients; 37 cases (57.81%) were male; the overall mortality rate was 31.25%(20/64). The clinical symptoms were diverse and nonspecific, with dyspnea being the most common (39/64, 60.94%). Heart biomarkers were elevated in 94.64%(53/56) of the patients. 35 patients (54.69%, 35/64) developed myocarditis after 1-2 doses and 17 patients died. 60 patients received steroids as initial treatment, and immunosuppressive therapies such as infliximab, intravenous immunoglobulin, antithymic globulin, and/or plasmapheresis were used in 25 patients, symptoms improved in 17 cases (68.00%).Conclusions:ICIs can cause myocarditis, with high mortality, and should be closely monitored and timely treatment. Steroids can be used as initial first-line therapy and immunosuppressants and/or plasmapheresis may improve clinical symptoms and survival rate.