Cardiotoxicity Related to Immune Checkpoint Inhibitors

被引：2

作者：

Ederhy, Stophane ^{[1
,2
]}

Benhamou-Tarallo, Iris ^{[1
]}

Chauvet-Droit, Marion ^{[1
]}

Nhan, Pascal ^{[1
]}

Cohen, Raphael ^{[1
]}

Pinna, Bruno ^{[2
,3
]}

Cholet, Clement ^{[1
]}

Fenioux, Charlotte ^{[2
,3
]}

Champiat, Stephane ^{[4
]}

Salem, Joe-Elie ^{[2
,3
,5
]}

Soulat-Dufour, Laurie ^{[1
,6
]}

Cohen, Ariel A. ^{[1
,2
,6
]}

机构：

[1] Sorbonne Univ, St Antoine Hosp, AP HP, Dept Cardiol, Paris, France

[2] Sorbonne Univ, AP HP, UNICO GRECO, Sorbonne Cardiooncol Program, Paris, France

[3] Sorbonne Univ, Pitie Salpetriere Hosp, AP HP Sorbonne, Dept Pharmacol,INSERM CIC 1901, Paris, France

[4] Inst Gustave Roussy, SITEP, Villejuif, France

[5] Vanderbilt Univ, Med Ctr, Div Med & Pharmacol, Cardiooncol Program, Nashville, TN USA

[6] Sorbonne Univ, Unite Rech Malad Cardiovasc Metabotisme & Nutr, Unite INSERM UMRS ICAN 1166, F-75013 Paris, France

来源：

CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE | 2021年 / 23卷 / 01期

关键词：

Myocarditis; Immune checkpoint inhibitor; Cardiotoxicity; Cancer;

D O I：

10.1007/s11936-020-00878-y

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Purpose of review Immune checkpoint inhibitors (ICI) have modified the management of patients with cancer. Their administration is associated with an increased risk of toxicities that can affect every organ. Cardiovascular toxicities, particularly myocarditis, can occur with a low incidence (< 1%) in patients treated with ICI, but with a high fatality rate (30-50%). In this review, we discuss the mechanisms, diagnostic work-up, and management of cardiovascular toxicities associated with ICI. Recent findings The main mechanisms of ICI-related myocarditis were first described in 2016 and are due to an infiltrate comprised T cells positive for CD3+, CD4+, and CD8+ and macrophages positive for CD68. The diagnosis of ICI-associated myocarditis remains challenging and is made on the combination of a clinical syndrome, an electrocardiogram (ECG), biomarker data, and imaging criteria. In most clinical scenarios, endomyocardial biopsy now plays a pivotal role, and the limitation of CMR in this context should be recognized. Glucocorticoids (oral or intravenous) are the first-line treatment for myocarditis confirmed by CMR and/or endomyocardial biopsy. The management of steroid-refractory myocarditis relies on the initiation of immunosuppressive therapies (ATG, infliximab, mycophenolate mofetil, and/or abatacept). However, the potential role of these drugs should be confirmed in well-designed prospective trials, as none of these strategies has been thoroughly evaluated prospectively. ICI-related myocarditis is an emerging toxicity in patients treated with immunotherapy. The diagnosis should be made promptly since it is associated with a high fatality rate. Corticosteroids are considered as the first-line treatment.

引用

页数：11

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