Immune checkpoint inhibitor-associated myocarditis: from pathophysiology to rechallenge of therapy – a narrative review

• Published in: Future cardiology Vol. 19; no. 2; pp. 91 - 103
• Main Authors: Tedeschi, Andrea, Camilli, Massimiliano, Ammirati, Enrico, Gentile, Piero, Palazzini, Matteo, Conti, Nicolina, Verde, Alessandro, Masciocco, Gabriella, Foti, Grazia, Giannattasio, Cristina, Garascia, Andrea
• Format: Journal Article
• Language: English
• Published: England Future Medicine Ltd 01.02.2023
• Subjects: cardiotoxicity; Electrocardiography; Humans; immune checkpoint inhibitors; Immune Checkpoint Inhibitors - adverse effects; immune-related adverse events; Immunotherapy - adverse effects; Immunotherapy - methods; myocarditis; Myocarditis - chemically induced; Myocarditis - diagnosis; rechallenge therapy; rechallenge therapy; cardiotoxicity; immune checkpoint inhibitors; myocarditis; immune-related adverse events
• ISSN: 1479-6678; 1744-8298
• DOI: 10.2217/fca-2022-0120

Even if immune checkpoint inhibitors have revolutionized the landscape of cancer therapy, their use may be complicated by immune-related adverse events. Among these, myocarditis is the most severe complication. The clinical suspicion often arises after clinical symptoms onset and increase in cardiac biomarkers or electrocardiographic manifestations. Echocardiography and cardiac magnetic resonance imaging are recommended for each patient. However, since they may be misleadingly normal, endomyocardial biopsy remains the gold standard for establishing the diagnosis. Until now, treatment has been based on glucocorticoids even if increasing interest has risen in other immunosuppressive agents. Although myocarditis currently imposes immunotherapy discontinuation, case reports have suggested a safety rechallenge in low-grade myocarditis paving the way for further studies to respond to this unmet clinical need.